HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [43926]
|
Facility
|
IP
|
$31.20
|
|
Service Code
|
HCPCS J1171
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$19.56 |
Max. Negotiated Rate |
$31.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.58
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
Rate for Payer: Altius Auto/Workers Compensation |
$29.95
|
Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
Rate for Payer: Altius Commercial |
$25.20
|
Rate for Payer: Altius Commercial |
$29.95
|
Rate for Payer: Beech Street Commercial |
$30.58
|
Rate for Payer: Beech Street Commercial |
$25.72
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.62
|
Rate for Payer: Cash Price |
$21.84
|
Rate for Payer: Cash Price |
$18.38
|
Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
Rate for Payer: ChoiceCare Network Commercial |
$30.26
|
Rate for Payer: Cigna of WY Commercial |
$30.58
|
Rate for Payer: Cigna of WY Commercial |
$25.72
|
Rate for Payer: Entrust Commercial |
$24.94
|
Rate for Payer: Entrust Commercial |
$29.64
|
Rate for Payer: First Choice Health Commercial |
$24.94
|
Rate for Payer: First Choice Health Commercial |
$29.64
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.64
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.59
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.32
|
Rate for Payer: HealthUtah PPO |
$31.20
|
Rate for Payer: HealthUtah PPO |
$26.25
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.26
|
Rate for Payer: Multiplan Medicare/VA |
$19.56
|
Rate for Payer: Multiplan Medicare/VA |
$16.46
|
Rate for Payer: One Health Plan of WY PPO |
$30.58
|
Rate for Payer: One Health Plan of WY PPO |
$25.72
|
Rate for Payer: PacificSource Commercial |
$28.08
|
Rate for Payer: PacificSource Commercial |
$23.62
|
Rate for Payer: PHCS PPO |
$25.72
|
Rate for Payer: PHCS PPO |
$30.58
|
Rate for Payer: Three Rivers PPO |
$19.69
|
Rate for Payer: Three Rivers PPO |
$23.40
|
Rate for Payer: TriWest Veterans Administration |
$20.59
|
Rate for Payer: TriWest Veterans Administration |
$17.32
|
Rate for Payer: United Healthcare Commercial |
$22.84
|
Rate for Payer: United Healthcare Commercial |
$27.14
|
Rate for Payer: United Healthcare Medicare |
$20.59
|
Rate for Payer: United Healthcare Medicare |
$17.32
|
Rate for Payer: WINHealth Partners Commercial |
$24.94
|
Rate for Payer: WINHealth Partners Commercial |
$29.64
|
Rate for Payer: Wise Provider Network Commercial |
$24.94
|
Rate for Payer: Wise Provider Network Commercial |
$29.64
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [43926]
|
Facility
|
OP
|
$31.20
|
|
Service Code
|
HCPCS J1171
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17.19 |
Max. Negotiated Rate |
$31.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.58
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
Rate for Payer: Aetna of WY Medicare |
$20.59
|
Rate for Payer: Aetna of WY Medicare |
$17.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$25.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$29.95
|
Rate for Payer: Altius Commercial |
$29.95
|
Rate for Payer: Altius Commercial |
$25.20
|
Rate for Payer: Beech Street Commercial |
$25.72
|
Rate for Payer: Beech Street Commercial |
$30.58
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.62
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.55
|
Rate for Payer: Cash Price |
$18.38
|
Rate for Payer: Cash Price |
$21.84
|
Rate for Payer: ChoiceCare Network Commercial |
$30.26
|
Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
Rate for Payer: Cigna of WY Commercial |
$25.72
|
Rate for Payer: Cigna of WY Commercial |
$30.58
|
Rate for Payer: Entrust Commercial |
$29.64
|
Rate for Payer: Entrust Commercial |
$24.94
|
Rate for Payer: First Choice Health Commercial |
$24.94
|
Rate for Payer: First Choice Health Commercial |
$29.64
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.64
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.22
|
Rate for Payer: HealthUtah PPO |
$26.25
|
Rate for Payer: HealthUtah PPO |
$31.20
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.26
|
Rate for Payer: Multiplan Medicare/VA |
$17.19
|
Rate for Payer: Multiplan Medicare/VA |
$14.46
|
Rate for Payer: One Health Plan of WY PPO |
$25.72
|
Rate for Payer: One Health Plan of WY PPO |
$30.58
|
Rate for Payer: PacificSource Commercial |
$28.08
|
Rate for Payer: PacificSource Commercial |
$23.62
|
Rate for Payer: PHCS PPO |
$25.72
|
Rate for Payer: PHCS PPO |
$30.58
|
Rate for Payer: Three Rivers PPO |
$19.69
|
Rate for Payer: Three Rivers PPO |
$23.40
|
Rate for Payer: TriWest Veterans Administration |
$18.10
|
Rate for Payer: TriWest Veterans Administration |
$15.22
|
Rate for Payer: United Healthcare Commercial |
$22.84
|
Rate for Payer: United Healthcare Commercial |
$27.14
|
Rate for Payer: United Healthcare Medicare |
$18.10
|
Rate for Payer: United Healthcare Medicare |
$15.22
|
Rate for Payer: WINHealth Partners Commercial |
$25.72
|
Rate for Payer: WINHealth Partners Commercial |
$30.58
|
Rate for Payer: Wise Provider Network Commercial |
$24.94
|
Rate for Payer: Wise Provider Network Commercial |
$29.64
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION [94090]
|
Facility
|
OP
|
$1,013.00
|
|
Service Code
|
HCPCS J3424
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$558.16 |
Max. Negotiated Rate |
$1,013.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$992.74
|
Rate for Payer: Aetna of WY Medicare |
$668.58
|
Rate for Payer: Altius Auto/Workers Compensation |
$972.48
|
Rate for Payer: Altius Commercial |
$972.48
|
Rate for Payer: Beech Street Commercial |
$992.74
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$831.67
|
Rate for Payer: Cash Price |
$709.10
|
Rate for Payer: ChoiceCare Network Commercial |
$982.61
|
Rate for Payer: Cigna of WY Commercial |
$992.74
|
Rate for Payer: Entrust Commercial |
$962.35
|
Rate for Payer: First Choice Health Commercial |
$962.35
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$962.35
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$587.54
|
Rate for Payer: HealthUtah PPO |
$1,013.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$982.61
|
Rate for Payer: Multiplan Medicare/VA |
$558.16
|
Rate for Payer: One Health Plan of WY PPO |
$992.74
|
Rate for Payer: PacificSource Commercial |
$911.70
|
Rate for Payer: PHCS PPO |
$992.74
|
Rate for Payer: Three Rivers PPO |
$759.75
|
Rate for Payer: TriWest Veterans Administration |
$587.54
|
Rate for Payer: United Healthcare Commercial |
$881.31
|
Rate for Payer: United Healthcare Medicare |
$587.54
|
Rate for Payer: WINHealth Partners Commercial |
$992.74
|
Rate for Payer: Wise Provider Network Commercial |
$962.35
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION [94090]
|
Facility
|
IP
|
$1,013.00
|
|
Service Code
|
HCPCS J3424
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$635.15 |
Max. Negotiated Rate |
$1,013.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$992.74
|
Rate for Payer: Altius Auto/Workers Compensation |
$972.48
|
Rate for Payer: Altius Commercial |
$972.48
|
Rate for Payer: Beech Street Commercial |
$992.74
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$831.67
|
Rate for Payer: Cash Price |
$709.10
|
Rate for Payer: ChoiceCare Network Commercial |
$982.61
|
Rate for Payer: Cigna of WY Commercial |
$992.74
|
Rate for Payer: Entrust Commercial |
$962.35
|
Rate for Payer: First Choice Health Commercial |
$962.35
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$962.35
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$668.58
|
Rate for Payer: HealthUtah PPO |
$1,013.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$982.61
|
Rate for Payer: Multiplan Medicare/VA |
$635.15
|
Rate for Payer: One Health Plan of WY PPO |
$992.74
|
Rate for Payer: PacificSource Commercial |
$911.70
|
Rate for Payer: PHCS PPO |
$992.74
|
Rate for Payer: Three Rivers PPO |
$759.75
|
Rate for Payer: TriWest Veterans Administration |
$668.58
|
Rate for Payer: United Healthcare Commercial |
$881.31
|
Rate for Payer: United Healthcare Medicare |
$668.58
|
Rate for Payer: WINHealth Partners Commercial |
$962.35
|
Rate for Payer: Wise Provider Network Commercial |
$962.35
|
|
HYDROXYCHLOROQUINE 200 MG TABLET [17268]
|
Facility
|
IP
|
$7.80
|
|
Service Code
|
NDC 6808426911
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$4.89 |
Max. Negotiated Rate |
$7.80 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.64
|
Rate for Payer: Altius Auto/Workers Compensation |
$7.49
|
Rate for Payer: Altius Commercial |
$7.49
|
Rate for Payer: Beech Street Commercial |
$7.64
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.40
|
Rate for Payer: Cash Price |
$5.46
|
Rate for Payer: ChoiceCare Network Commercial |
$7.57
|
Rate for Payer: Cigna of WY Commercial |
$7.64
|
Rate for Payer: Entrust Commercial |
$7.41
|
Rate for Payer: First Choice Health Commercial |
$7.41
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.41
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.15
|
Rate for Payer: HealthUtah PPO |
$7.80
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.57
|
Rate for Payer: Multiplan Medicare/VA |
$4.89
|
Rate for Payer: One Health Plan of WY PPO |
$7.64
|
Rate for Payer: PacificSource Commercial |
$7.02
|
Rate for Payer: PHCS PPO |
$7.64
|
Rate for Payer: Three Rivers PPO |
$5.85
|
Rate for Payer: TriWest Veterans Administration |
$5.15
|
Rate for Payer: United Healthcare Commercial |
$6.79
|
Rate for Payer: United Healthcare Medicare |
$5.15
|
Rate for Payer: WINHealth Partners Commercial |
$7.41
|
Rate for Payer: Wise Provider Network Commercial |
$7.41
|
|
HYDROXYCHLOROQUINE 200 MG TABLET [17268]
|
Facility
|
OP
|
$7.80
|
|
Service Code
|
NDC 6808426911
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$4.30 |
Max. Negotiated Rate |
$7.80 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.64
|
Rate for Payer: Aetna of WY Medicare |
$5.15
|
Rate for Payer: Altius Auto/Workers Compensation |
$7.49
|
Rate for Payer: Altius Commercial |
$7.49
|
Rate for Payer: Beech Street Commercial |
$7.64
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.40
|
Rate for Payer: Cash Price |
$5.46
|
Rate for Payer: ChoiceCare Network Commercial |
$7.57
|
Rate for Payer: Cigna of WY Commercial |
$7.64
|
Rate for Payer: Entrust Commercial |
$7.41
|
Rate for Payer: First Choice Health Commercial |
$7.41
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.41
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.52
|
Rate for Payer: HealthUtah PPO |
$7.80
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.57
|
Rate for Payer: Multiplan Medicare/VA |
$4.30
|
Rate for Payer: One Health Plan of WY PPO |
$7.64
|
Rate for Payer: PacificSource Commercial |
$7.02
|
Rate for Payer: PHCS PPO |
$7.64
|
Rate for Payer: Three Rivers PPO |
$5.85
|
Rate for Payer: TriWest Veterans Administration |
$4.52
|
Rate for Payer: United Healthcare Commercial |
$6.79
|
Rate for Payer: United Healthcare Medicare |
$4.52
|
Rate for Payer: WINHealth Partners Commercial |
$7.64
|
Rate for Payer: Wise Provider Network Commercial |
$7.41
|
|
HYDROXYPROGESTERONE CAPROATE
|
Professional
|
Both
|
$4.00
|
|
Service Code
|
HCPCS J1725
|
Hospital Charge Code |
J1725
|
Min. Negotiated Rate |
$3.00 |
Max. Negotiated Rate |
$4.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
Rate for Payer: Beech Street Commercial |
$3.80
|
Rate for Payer: Cash Price |
$2.80
|
Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
Rate for Payer: Cigna of WY Commercial |
$3.92
|
Rate for Payer: First Choice Health Commercial |
$3.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
Rate for Payer: HealthUtah PPO |
$4.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
Rate for Payer: One Health Plan of WY PPO |
$3.92
|
Rate for Payer: PacificSource Commercial |
$3.60
|
Rate for Payer: PHCS PPO |
$3.80
|
Rate for Payer: Three Rivers PPO |
$3.00
|
Rate for Payer: United Healthcare Commercial |
$3.48
|
Rate for Payer: WINHealth Partners Commercial |
$3.80
|
|
HYDROXYZINE HCL INJECTION
|
Professional
|
Both
|
$12.00
|
|
Service Code
|
HCPCS J3410
|
Hospital Charge Code |
J3410
|
Min. Negotiated Rate |
$9.00 |
Max. Negotiated Rate |
$13.87 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
Rate for Payer: Aetna of WY Medicare |
$13.87
|
Rate for Payer: Beech Street Commercial |
$11.40
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
Rate for Payer: Cigna of WY Commercial |
$11.76
|
Rate for Payer: First Choice Health Commercial |
$10.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.87
|
Rate for Payer: HealthUtah PPO |
$12.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
Rate for Payer: Multiplan Medicare/VA |
$11.79
|
Rate for Payer: One Health Plan of WY PPO |
$11.76
|
Rate for Payer: PacificSource Commercial |
$10.80
|
Rate for Payer: PHCS PPO |
$11.40
|
Rate for Payer: Three Rivers PPO |
$9.00
|
Rate for Payer: TriWest Veterans Administration |
$13.87
|
Rate for Payer: United Healthcare Commercial |
$10.44
|
Rate for Payer: United Healthcare Medicare |
$13.87
|
Rate for Payer: WINHealth Partners Commercial |
$11.40
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
OP
|
$2.00
|
|
Service Code
|
NDC 6808484701
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.10 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
Rate for Payer: Aetna of WY Medicare |
$1.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
Rate for Payer: Altius Commercial |
$1.92
|
Rate for Payer: Beech Street Commercial |
$1.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
Rate for Payer: Cigna of WY Commercial |
$1.96
|
Rate for Payer: Entrust Commercial |
$1.90
|
Rate for Payer: First Choice Health Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
Rate for Payer: HealthUtah PPO |
$2.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
Rate for Payer: Multiplan Medicare/VA |
$1.10
|
Rate for Payer: One Health Plan of WY PPO |
$1.96
|
Rate for Payer: PacificSource Commercial |
$1.80
|
Rate for Payer: PHCS PPO |
$1.96
|
Rate for Payer: Three Rivers PPO |
$1.50
|
Rate for Payer: TriWest Veterans Administration |
$1.16
|
Rate for Payer: United Healthcare Commercial |
$1.74
|
Rate for Payer: United Healthcare Medicare |
$1.16
|
Rate for Payer: WINHealth Partners Commercial |
$1.96
|
Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
IP
|
$2.00
|
|
Service Code
|
NDC 6808484711
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.25 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
Rate for Payer: Altius Commercial |
$1.92
|
Rate for Payer: Beech Street Commercial |
$1.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
Rate for Payer: Cigna of WY Commercial |
$1.96
|
Rate for Payer: Entrust Commercial |
$1.90
|
Rate for Payer: First Choice Health Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
Rate for Payer: HealthUtah PPO |
$2.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
Rate for Payer: Multiplan Medicare/VA |
$1.25
|
Rate for Payer: One Health Plan of WY PPO |
$1.96
|
Rate for Payer: PacificSource Commercial |
$1.80
|
Rate for Payer: PHCS PPO |
$1.96
|
Rate for Payer: Three Rivers PPO |
$1.50
|
Rate for Payer: TriWest Veterans Administration |
$1.32
|
Rate for Payer: United Healthcare Commercial |
$1.74
|
Rate for Payer: United Healthcare Medicare |
$1.32
|
Rate for Payer: WINHealth Partners Commercial |
$1.90
|
Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
IP
|
$2.00
|
|
Service Code
|
NDC 6808484701
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.25 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
Rate for Payer: Altius Commercial |
$1.92
|
Rate for Payer: Beech Street Commercial |
$1.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
Rate for Payer: Cigna of WY Commercial |
$1.96
|
Rate for Payer: Entrust Commercial |
$1.90
|
Rate for Payer: First Choice Health Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
Rate for Payer: HealthUtah PPO |
$2.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
Rate for Payer: Multiplan Medicare/VA |
$1.25
|
Rate for Payer: One Health Plan of WY PPO |
$1.96
|
Rate for Payer: PacificSource Commercial |
$1.80
|
Rate for Payer: PHCS PPO |
$1.96
|
Rate for Payer: Three Rivers PPO |
$1.50
|
Rate for Payer: TriWest Veterans Administration |
$1.32
|
Rate for Payer: United Healthcare Commercial |
$1.74
|
Rate for Payer: United Healthcare Medicare |
$1.32
|
Rate for Payer: WINHealth Partners Commercial |
$1.90
|
Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
OP
|
$2.00
|
|
Service Code
|
NDC 6808484711
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.10 |
Max. Negotiated Rate |
$2.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
Rate for Payer: Aetna of WY Medicare |
$1.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
Rate for Payer: Altius Commercial |
$1.92
|
Rate for Payer: Beech Street Commercial |
$1.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
Rate for Payer: Cash Price |
$1.40
|
Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
Rate for Payer: Cigna of WY Commercial |
$1.96
|
Rate for Payer: Entrust Commercial |
$1.90
|
Rate for Payer: First Choice Health Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
Rate for Payer: HealthUtah PPO |
$2.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
Rate for Payer: Multiplan Medicare/VA |
$1.10
|
Rate for Payer: One Health Plan of WY PPO |
$1.96
|
Rate for Payer: PacificSource Commercial |
$1.80
|
Rate for Payer: PHCS PPO |
$1.96
|
Rate for Payer: Three Rivers PPO |
$1.50
|
Rate for Payer: TriWest Veterans Administration |
$1.16
|
Rate for Payer: United Healthcare Commercial |
$1.74
|
Rate for Payer: United Healthcare Medicare |
$1.16
|
Rate for Payer: WINHealth Partners Commercial |
$1.96
|
Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
OP
|
$1.92
|
|
Service Code
|
NDC 6068769611
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.06 |
Max. Negotiated Rate |
$1.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.88
|
Rate for Payer: Aetna of WY Medicare |
$1.27
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.84
|
Rate for Payer: Altius Commercial |
$1.84
|
Rate for Payer: Beech Street Commercial |
$1.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.58
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: ChoiceCare Network Commercial |
$1.86
|
Rate for Payer: Cigna of WY Commercial |
$1.88
|
Rate for Payer: Entrust Commercial |
$1.82
|
Rate for Payer: First Choice Health Commercial |
$1.82
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.82
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.11
|
Rate for Payer: HealthUtah PPO |
$1.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.86
|
Rate for Payer: Multiplan Medicare/VA |
$1.06
|
Rate for Payer: One Health Plan of WY PPO |
$1.88
|
Rate for Payer: PacificSource Commercial |
$1.73
|
Rate for Payer: PHCS PPO |
$1.88
|
Rate for Payer: Three Rivers PPO |
$1.44
|
Rate for Payer: TriWest Veterans Administration |
$1.11
|
Rate for Payer: United Healthcare Commercial |
$1.67
|
Rate for Payer: United Healthcare Medicare |
$1.11
|
Rate for Payer: WINHealth Partners Commercial |
$1.88
|
Rate for Payer: Wise Provider Network Commercial |
$1.82
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [20605]
|
Facility
|
IP
|
$1.92
|
|
Service Code
|
NDC 6068769611
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.20 |
Max. Negotiated Rate |
$1.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.84
|
Rate for Payer: Altius Commercial |
$1.84
|
Rate for Payer: Beech Street Commercial |
$1.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.58
|
Rate for Payer: Cash Price |
$1.35
|
Rate for Payer: ChoiceCare Network Commercial |
$1.86
|
Rate for Payer: Cigna of WY Commercial |
$1.88
|
Rate for Payer: Entrust Commercial |
$1.82
|
Rate for Payer: First Choice Health Commercial |
$1.82
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.82
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.27
|
Rate for Payer: HealthUtah PPO |
$1.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.86
|
Rate for Payer: Multiplan Medicare/VA |
$1.20
|
Rate for Payer: One Health Plan of WY PPO |
$1.88
|
Rate for Payer: PacificSource Commercial |
$1.73
|
Rate for Payer: PHCS PPO |
$1.88
|
Rate for Payer: Three Rivers PPO |
$1.44
|
Rate for Payer: TriWest Veterans Administration |
$1.27
|
Rate for Payer: United Healthcare Commercial |
$1.67
|
Rate for Payer: United Healthcare Medicare |
$1.27
|
Rate for Payer: WINHealth Partners Commercial |
$1.82
|
Rate for Payer: Wise Provider Network Commercial |
$1.82
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [2463]
|
Facility
|
OP
|
$300.34
|
|
Service Code
|
HCPCS J7325
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$165.49 |
Max. Negotiated Rate |
$300.34 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.33
|
Rate for Payer: Aetna of WY Medicare |
$198.22
|
Rate for Payer: Altius Auto/Workers Compensation |
$288.33
|
Rate for Payer: Altius Commercial |
$288.33
|
Rate for Payer: Beech Street Commercial |
$294.33
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.58
|
Rate for Payer: Cash Price |
$210.24
|
Rate for Payer: ChoiceCare Network Commercial |
$291.33
|
Rate for Payer: Cigna of WY Commercial |
$294.33
|
Rate for Payer: Entrust Commercial |
$285.32
|
Rate for Payer: First Choice Health Commercial |
$285.32
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.32
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.20
|
Rate for Payer: HealthUtah PPO |
$300.34
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.33
|
Rate for Payer: Multiplan Medicare/VA |
$165.49
|
Rate for Payer: One Health Plan of WY PPO |
$294.33
|
Rate for Payer: PacificSource Commercial |
$270.31
|
Rate for Payer: PHCS PPO |
$294.33
|
Rate for Payer: Three Rivers PPO |
$225.26
|
Rate for Payer: TriWest Veterans Administration |
$174.20
|
Rate for Payer: United Healthcare Commercial |
$261.30
|
Rate for Payer: United Healthcare Medicare |
$174.20
|
Rate for Payer: WINHealth Partners Commercial |
$294.33
|
Rate for Payer: Wise Provider Network Commercial |
$285.32
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [2463]
|
Facility
|
IP
|
$300.34
|
|
Service Code
|
HCPCS J7325
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$188.31 |
Max. Negotiated Rate |
$300.34 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.33
|
Rate for Payer: Altius Auto/Workers Compensation |
$288.33
|
Rate for Payer: Altius Commercial |
$288.33
|
Rate for Payer: Beech Street Commercial |
$294.33
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.58
|
Rate for Payer: Cash Price |
$210.24
|
Rate for Payer: ChoiceCare Network Commercial |
$291.33
|
Rate for Payer: Cigna of WY Commercial |
$294.33
|
Rate for Payer: Entrust Commercial |
$285.32
|
Rate for Payer: First Choice Health Commercial |
$285.32
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.32
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.22
|
Rate for Payer: HealthUtah PPO |
$300.34
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.33
|
Rate for Payer: Multiplan Medicare/VA |
$188.31
|
Rate for Payer: One Health Plan of WY PPO |
$294.33
|
Rate for Payer: PacificSource Commercial |
$270.31
|
Rate for Payer: PHCS PPO |
$294.33
|
Rate for Payer: Three Rivers PPO |
$225.26
|
Rate for Payer: TriWest Veterans Administration |
$198.22
|
Rate for Payer: United Healthcare Commercial |
$261.30
|
Rate for Payer: United Healthcare Medicare |
$198.22
|
Rate for Payer: WINHealth Partners Commercial |
$285.32
|
Rate for Payer: Wise Provider Network Commercial |
$285.32
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE [86227]
|
Facility
|
IP
|
$357.40
|
|
Service Code
|
HCPCS J7325
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$224.09 |
Max. Negotiated Rate |
$357.40 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.25
|
Rate for Payer: Altius Auto/Workers Compensation |
$343.10
|
Rate for Payer: Altius Commercial |
$343.10
|
Rate for Payer: Beech Street Commercial |
$350.25
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.43
|
Rate for Payer: Cash Price |
$250.18
|
Rate for Payer: ChoiceCare Network Commercial |
$346.68
|
Rate for Payer: Cigna of WY Commercial |
$350.25
|
Rate for Payer: Entrust Commercial |
$339.53
|
Rate for Payer: First Choice Health Commercial |
$339.53
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$339.53
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$235.88
|
Rate for Payer: HealthUtah PPO |
$357.40
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$346.68
|
Rate for Payer: Multiplan Medicare/VA |
$224.09
|
Rate for Payer: One Health Plan of WY PPO |
$350.25
|
Rate for Payer: PacificSource Commercial |
$321.66
|
Rate for Payer: PHCS PPO |
$350.25
|
Rate for Payer: Three Rivers PPO |
$268.05
|
Rate for Payer: TriWest Veterans Administration |
$235.88
|
Rate for Payer: United Healthcare Commercial |
$310.94
|
Rate for Payer: United Healthcare Medicare |
$235.88
|
Rate for Payer: WINHealth Partners Commercial |
$339.53
|
Rate for Payer: Wise Provider Network Commercial |
$339.53
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE [86227]
|
Facility
|
OP
|
$357.40
|
|
Service Code
|
HCPCS J7325
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$196.93 |
Max. Negotiated Rate |
$357.40 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.25
|
Rate for Payer: Aetna of WY Medicare |
$235.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$343.10
|
Rate for Payer: Altius Commercial |
$343.10
|
Rate for Payer: Beech Street Commercial |
$350.25
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.43
|
Rate for Payer: Cash Price |
$250.18
|
Rate for Payer: ChoiceCare Network Commercial |
$346.68
|
Rate for Payer: Cigna of WY Commercial |
$350.25
|
Rate for Payer: Entrust Commercial |
$339.53
|
Rate for Payer: First Choice Health Commercial |
$339.53
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$339.53
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.29
|
Rate for Payer: HealthUtah PPO |
$357.40
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$346.68
|
Rate for Payer: Multiplan Medicare/VA |
$196.93
|
Rate for Payer: One Health Plan of WY PPO |
$350.25
|
Rate for Payer: PacificSource Commercial |
$321.66
|
Rate for Payer: PHCS PPO |
$350.25
|
Rate for Payer: Three Rivers PPO |
$268.05
|
Rate for Payer: TriWest Veterans Administration |
$207.29
|
Rate for Payer: United Healthcare Commercial |
$310.94
|
Rate for Payer: United Healthcare Medicare |
$207.29
|
Rate for Payer: WINHealth Partners Commercial |
$350.25
|
Rate for Payer: Wise Provider Network Commercial |
$339.53
|
|
HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$1,638.00
|
|
Service Code
|
HCPCS 56442
|
Hospital Charge Code |
56442
|
Min. Negotiated Rate |
$38.93 |
Max. Negotiated Rate |
$1,638.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
Rate for Payer: Aetna of WY Medicare |
$45.80
|
Rate for Payer: Beech Street Commercial |
$1,556.10
|
Rate for Payer: Cash Price |
$1,146.60
|
Rate for Payer: Cash Price |
$1,146.60
|
Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
Rate for Payer: First Choice Health Commercial |
$1,474.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.80
|
Rate for Payer: HealthUtah PPO |
$1,638.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
Rate for Payer: Multiplan Medicare/VA |
$38.93
|
Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
Rate for Payer: PacificSource Commercial |
$1,474.20
|
Rate for Payer: PHCS PPO |
$1,556.10
|
Rate for Payer: Three Rivers PPO |
$1,228.50
|
Rate for Payer: TriWest Veterans Administration |
$45.80
|
Rate for Payer: United Healthcare Commercial |
$1,425.06
|
Rate for Payer: United Healthcare Medicare |
$45.80
|
Rate for Payer: WINHealth Partners Commercial |
$1,392.30
|
|
HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$676.00
|
|
Service Code
|
HCPCS 59350
|
Hospital Charge Code |
59350
|
Min. Negotiated Rate |
$221.64 |
Max. Negotiated Rate |
$676.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
Rate for Payer: Aetna of WY Medicare |
$260.75
|
Rate for Payer: Beech Street Commercial |
$642.20
|
Rate for Payer: Cash Price |
$473.20
|
Rate for Payer: Cash Price |
$473.20
|
Rate for Payer: ChoiceCare Network Commercial |
$655.72
|
Rate for Payer: Cigna of WY Commercial |
$662.48
|
Rate for Payer: First Choice Health Commercial |
$608.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$642.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.75
|
Rate for Payer: HealthUtah PPO |
$676.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
Rate for Payer: Multiplan Medicare/VA |
$221.64
|
Rate for Payer: One Health Plan of WY PPO |
$662.48
|
Rate for Payer: PacificSource Commercial |
$608.40
|
Rate for Payer: PHCS PPO |
$642.20
|
Rate for Payer: Three Rivers PPO |
$507.00
|
Rate for Payer: TriWest Veterans Administration |
$260.75
|
Rate for Payer: United Healthcare Commercial |
$588.12
|
Rate for Payer: United Healthcare Medicare |
$260.75
|
Rate for Payer: WINHealth Partners Commercial |
$574.60
|
|
HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$2,321.00
|
|
Service Code
|
HCPCS 58565
|
Hospital Charge Code |
58565
|
Min. Negotiated Rate |
$376.41 |
Max. Negotiated Rate |
$2,321.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,274.58
|
Rate for Payer: Aetna of WY Medicare |
$442.84
|
Rate for Payer: Beech Street Commercial |
$2,204.95
|
Rate for Payer: Cash Price |
$1,624.70
|
Rate for Payer: Cash Price |
$1,624.70
|
Rate for Payer: ChoiceCare Network Commercial |
$2,251.37
|
Rate for Payer: Cigna of WY Commercial |
$2,274.58
|
Rate for Payer: First Choice Health Commercial |
$2,088.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,204.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.84
|
Rate for Payer: HealthUtah PPO |
$2,321.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,251.37
|
Rate for Payer: Multiplan Medicare/VA |
$376.41
|
Rate for Payer: One Health Plan of WY PPO |
$2,274.58
|
Rate for Payer: PacificSource Commercial |
$2,088.90
|
Rate for Payer: PHCS PPO |
$2,204.95
|
Rate for Payer: Three Rivers PPO |
$1,740.75
|
Rate for Payer: TriWest Veterans Administration |
$442.84
|
Rate for Payer: United Healthcare Commercial |
$2,019.27
|
Rate for Payer: United Healthcare Medicare |
$442.84
|
Rate for Payer: WINHealth Partners Commercial |
$1,972.85
|
|
HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$4,324.00
|
|
Service Code
|
HCPCS 58558
|
Hospital Charge Code |
58558
|
Min. Negotiated Rate |
$187.44 |
Max. Negotiated Rate |
$4,324.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,237.52
|
Rate for Payer: Aetna of WY Medicare |
$220.52
|
Rate for Payer: Beech Street Commercial |
$4,107.80
|
Rate for Payer: Cash Price |
$3,026.80
|
Rate for Payer: Cash Price |
$3,026.80
|
Rate for Payer: ChoiceCare Network Commercial |
$4,194.28
|
Rate for Payer: Cigna of WY Commercial |
$4,237.52
|
Rate for Payer: First Choice Health Commercial |
$3,891.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,107.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.52
|
Rate for Payer: HealthUtah PPO |
$4,324.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,194.28
|
Rate for Payer: Multiplan Medicare/VA |
$187.44
|
Rate for Payer: One Health Plan of WY PPO |
$4,237.52
|
Rate for Payer: PacificSource Commercial |
$3,891.60
|
Rate for Payer: PHCS PPO |
$4,107.80
|
Rate for Payer: Three Rivers PPO |
$3,243.00
|
Rate for Payer: TriWest Veterans Administration |
$220.52
|
Rate for Payer: United Healthcare Commercial |
$3,761.88
|
Rate for Payer: United Healthcare Medicare |
$220.52
|
Rate for Payer: WINHealth Partners Commercial |
$3,675.40
|
|
HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,821.00
|
|
Service Code
|
HCPCS 58555
|
Hospital Charge Code |
58555
|
Min. Negotiated Rate |
$122.88 |
Max. Negotiated Rate |
$2,821.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,764.58
|
Rate for Payer: Aetna of WY Medicare |
$144.57
|
Rate for Payer: Beech Street Commercial |
$2,679.95
|
Rate for Payer: Cash Price |
$1,974.70
|
Rate for Payer: Cash Price |
$1,974.70
|
Rate for Payer: ChoiceCare Network Commercial |
$2,736.37
|
Rate for Payer: Cigna of WY Commercial |
$2,764.58
|
Rate for Payer: First Choice Health Commercial |
$2,538.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,679.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.57
|
Rate for Payer: HealthUtah PPO |
$2,821.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,736.37
|
Rate for Payer: Multiplan Medicare/VA |
$122.88
|
Rate for Payer: One Health Plan of WY PPO |
$2,764.58
|
Rate for Payer: PacificSource Commercial |
$2,538.90
|
Rate for Payer: PHCS PPO |
$2,679.95
|
Rate for Payer: Three Rivers PPO |
$2,115.75
|
Rate for Payer: TriWest Veterans Administration |
$144.57
|
Rate for Payer: United Healthcare Commercial |
$2,454.27
|
Rate for Payer: United Healthcare Medicare |
$144.57
|
Rate for Payer: WINHealth Partners Commercial |
$2,397.85
|
|
HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,316.00
|
|
Service Code
|
HCPCS 58560
|
Hospital Charge Code |
58560
|
Min. Negotiated Rate |
$253.11 |
Max. Negotiated Rate |
$1,316.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,289.68
|
Rate for Payer: Aetna of WY Medicare |
$297.78
|
Rate for Payer: Beech Street Commercial |
$1,250.20
|
Rate for Payer: Cash Price |
$921.20
|
Rate for Payer: Cash Price |
$921.20
|
Rate for Payer: ChoiceCare Network Commercial |
$1,276.52
|
Rate for Payer: Cigna of WY Commercial |
$1,289.68
|
Rate for Payer: First Choice Health Commercial |
$1,184.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,250.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.78
|
Rate for Payer: HealthUtah PPO |
$1,316.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,276.52
|
Rate for Payer: Multiplan Medicare/VA |
$253.11
|
Rate for Payer: One Health Plan of WY PPO |
$1,289.68
|
Rate for Payer: PacificSource Commercial |
$1,184.40
|
Rate for Payer: PHCS PPO |
$1,250.20
|
Rate for Payer: Three Rivers PPO |
$987.00
|
Rate for Payer: TriWest Veterans Administration |
$297.78
|
Rate for Payer: United Healthcare Commercial |
$1,144.92
|
Rate for Payer: United Healthcare Medicare |
$297.78
|
Rate for Payer: WINHealth Partners Commercial |
$1,118.60
|
|
HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$4,255.00
|
|
Service Code
|
HCPCS 58563
|
Hospital Charge Code |
58563
|
Min. Negotiated Rate |
$199.12 |
Max. Negotiated Rate |
$4,255.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,169.90
|
Rate for Payer: Aetna of WY Medicare |
$234.26
|
Rate for Payer: Beech Street Commercial |
$4,042.25
|
Rate for Payer: Cash Price |
$2,978.50
|
Rate for Payer: Cash Price |
$2,978.50
|
Rate for Payer: ChoiceCare Network Commercial |
$4,127.35
|
Rate for Payer: Cigna of WY Commercial |
$4,169.90
|
Rate for Payer: First Choice Health Commercial |
$3,829.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,042.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.26
|
Rate for Payer: HealthUtah PPO |
$4,255.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,127.35
|
Rate for Payer: Multiplan Medicare/VA |
$199.12
|
Rate for Payer: One Health Plan of WY PPO |
$4,169.90
|
Rate for Payer: PacificSource Commercial |
$3,829.50
|
Rate for Payer: PHCS PPO |
$4,042.25
|
Rate for Payer: Three Rivers PPO |
$3,191.25
|
Rate for Payer: TriWest Veterans Administration |
$234.26
|
Rate for Payer: United Healthcare Commercial |
$3,701.85
|
Rate for Payer: United Healthcare Medicare |
$234.26
|
Rate for Payer: WINHealth Partners Commercial |
$3,616.75
|
|