|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
NDC 4950239471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.07
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$22.87
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$24.07
|
| Rate for Payer: WINHealth Partners Commercial |
$34.65
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
NDC 8325701531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.07
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$22.87
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$24.07
|
| Rate for Payer: WINHealth Partners Commercial |
$34.65
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
NDC 4950239475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Aetna of WY Medicare |
$24.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.15
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$20.09
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$21.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.74
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
NDC 4950239475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.07
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$22.87
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$24.07
|
| Rate for Payer: WINHealth Partners Commercial |
$34.65
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
NDC 8325701531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Aetna of WY Medicare |
$24.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.15
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$20.09
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$21.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.74
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [162886]
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
NDC 4950239471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$36.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.74
|
| Rate for Payer: Aetna of WY Medicare |
$24.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.01
|
| Rate for Payer: Altius Commercial |
$35.01
|
| Rate for Payer: Beech Street Commercial |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.38
|
| Rate for Payer: Cigna of WY Commercial |
$35.74
|
| Rate for Payer: Entrust Commercial |
$34.65
|
| Rate for Payer: First Choice Health Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.15
|
| Rate for Payer: HealthUtah PPO |
$36.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.38
|
| Rate for Payer: Multiplan Medicare/VA |
$20.09
|
| Rate for Payer: One Health Plan of WY PPO |
$35.74
|
| Rate for Payer: PacificSource Commercial |
$32.82
|
| Rate for Payer: PHCS PPO |
$35.74
|
| Rate for Payer: Three Rivers PPO |
$27.35
|
| Rate for Payer: TriWest Veterans Administration |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$31.73
|
| Rate for Payer: United Healthcare Medicare |
$21.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.74
|
| Rate for Payer: Wise Provider Network Commercial |
$34.65
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [86450]
|
Facility
|
OP
|
$47.91
|
|
|
Service Code
|
NDC 0088250200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$47.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.95
|
| Rate for Payer: Aetna of WY Medicare |
$31.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.99
|
| Rate for Payer: Altius Commercial |
$45.99
|
| Rate for Payer: Beech Street Commercial |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.33
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.47
|
| Rate for Payer: Cigna of WY Commercial |
$46.95
|
| Rate for Payer: Entrust Commercial |
$45.51
|
| Rate for Payer: First Choice Health Commercial |
$45.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.79
|
| Rate for Payer: HealthUtah PPO |
$47.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.47
|
| Rate for Payer: Multiplan Medicare/VA |
$26.40
|
| Rate for Payer: One Health Plan of WY PPO |
$46.95
|
| Rate for Payer: PacificSource Commercial |
$43.12
|
| Rate for Payer: PHCS PPO |
$46.95
|
| Rate for Payer: Three Rivers PPO |
$35.93
|
| Rate for Payer: TriWest Veterans Administration |
$27.79
|
| Rate for Payer: United Healthcare Commercial |
$41.68
|
| Rate for Payer: United Healthcare Medicare |
$27.79
|
| Rate for Payer: WINHealth Partners Commercial |
$46.95
|
| Rate for Payer: Wise Provider Network Commercial |
$45.51
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [86450]
|
Facility
|
IP
|
$47.91
|
|
|
Service Code
|
NDC 0088250200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.04 |
| Max. Negotiated Rate |
$47.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.99
|
| Rate for Payer: Altius Commercial |
$45.99
|
| Rate for Payer: Beech Street Commercial |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.33
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.47
|
| Rate for Payer: Cigna of WY Commercial |
$46.95
|
| Rate for Payer: Entrust Commercial |
$45.51
|
| Rate for Payer: First Choice Health Commercial |
$45.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.62
|
| Rate for Payer: HealthUtah PPO |
$47.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.47
|
| Rate for Payer: Multiplan Medicare/VA |
$30.04
|
| Rate for Payer: One Health Plan of WY PPO |
$46.95
|
| Rate for Payer: PacificSource Commercial |
$43.12
|
| Rate for Payer: PHCS PPO |
$46.95
|
| Rate for Payer: Three Rivers PPO |
$35.93
|
| Rate for Payer: TriWest Veterans Administration |
$31.62
|
| Rate for Payer: United Healthcare Commercial |
$41.68
|
| Rate for Payer: United Healthcare Medicare |
$31.62
|
| Rate for Payer: WINHealth Partners Commercial |
$45.51
|
| Rate for Payer: Wise Provider Network Commercial |
$45.51
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [24502]
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
HCPCS J1815
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.88
|
| Rate for Payer: Aetna of WY Medicare |
$30.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.95
|
| Rate for Payer: Altius Commercial |
$44.95
|
| Rate for Payer: Beech Street Commercial |
$45.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.44
|
| Rate for Payer: Cash Price |
$32.77
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.42
|
| Rate for Payer: Cigna of WY Commercial |
$45.88
|
| Rate for Payer: Entrust Commercial |
$44.48
|
| Rate for Payer: First Choice Health Commercial |
$44.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.16
|
| Rate for Payer: HealthUtah PPO |
$46.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.42
|
| Rate for Payer: Multiplan Medicare/VA |
$25.80
|
| Rate for Payer: One Health Plan of WY PPO |
$45.88
|
| Rate for Payer: PacificSource Commercial |
$42.14
|
| Rate for Payer: PHCS PPO |
$45.88
|
| Rate for Payer: Three Rivers PPO |
$35.12
|
| Rate for Payer: TriWest Veterans Administration |
$27.16
|
| Rate for Payer: United Healthcare Commercial |
$40.73
|
| Rate for Payer: United Healthcare Medicare |
$27.16
|
| Rate for Payer: WINHealth Partners Commercial |
$45.88
|
| Rate for Payer: Wise Provider Network Commercial |
$44.48
|
|
|
INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN [24502]
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
HCPCS J1815
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.95
|
| Rate for Payer: Altius Commercial |
$44.95
|
| Rate for Payer: Beech Street Commercial |
$45.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.44
|
| Rate for Payer: Cash Price |
$32.77
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.42
|
| Rate for Payer: Cigna of WY Commercial |
$45.88
|
| Rate for Payer: Entrust Commercial |
$44.48
|
| Rate for Payer: First Choice Health Commercial |
$44.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.90
|
| Rate for Payer: HealthUtah PPO |
$46.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.42
|
| Rate for Payer: Multiplan Medicare/VA |
$29.36
|
| Rate for Payer: One Health Plan of WY PPO |
$45.88
|
| Rate for Payer: PacificSource Commercial |
$42.14
|
| Rate for Payer: PHCS PPO |
$45.88
|
| Rate for Payer: Three Rivers PPO |
$35.12
|
| Rate for Payer: TriWest Veterans Administration |
$30.90
|
| Rate for Payer: United Healthcare Commercial |
$40.73
|
| Rate for Payer: United Healthcare Medicare |
$30.90
|
| Rate for Payer: WINHealth Partners Commercial |
$44.48
|
| Rate for Payer: Wise Provider Network Commercial |
$44.48
|
|
|
INSULIN (MYREDILIN) BOLUS FROM BAG [4090000076]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 0338012612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
INSULIN (MYREDILIN) BOLUS FROM BAG [4090000076]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 0338012612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.37
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [156295]
|
Facility
|
OP
|
$1.40
|
|
|
Service Code
|
NDC 0338012612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.37
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [156295]
|
Facility
|
IP
|
$1.40
|
|
|
Service Code
|
NDC 0338012612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.34
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [13108]
|
Facility
|
OP
|
$55.89
|
|
|
Service Code
|
HCPCS J1817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$55.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.77
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.10
|
| Rate for Payer: Aetna of WY Medicare |
$36.89
|
| Rate for Payer: Aetna of WY Medicare |
$20.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.65
|
| Rate for Payer: Altius Commercial |
$53.65
|
| Rate for Payer: Altius Commercial |
$30.46
|
| Rate for Payer: Beech Street Commercial |
$31.10
|
| Rate for Payer: Beech Street Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.05
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.78
|
| Rate for Payer: Cigna of WY Commercial |
$31.10
|
| Rate for Payer: Cigna of WY Commercial |
$54.77
|
| Rate for Payer: Entrust Commercial |
$53.10
|
| Rate for Payer: Entrust Commercial |
$30.14
|
| Rate for Payer: First Choice Health Commercial |
$30.14
|
| Rate for Payer: First Choice Health Commercial |
$53.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.40
|
| Rate for Payer: HealthUtah PPO |
$31.73
|
| Rate for Payer: HealthUtah PPO |
$55.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.21
|
| Rate for Payer: Multiplan Medicare/VA |
$30.80
|
| Rate for Payer: Multiplan Medicare/VA |
$17.48
|
| Rate for Payer: One Health Plan of WY PPO |
$31.10
|
| Rate for Payer: One Health Plan of WY PPO |
$54.77
|
| Rate for Payer: PacificSource Commercial |
$50.30
|
| Rate for Payer: PacificSource Commercial |
$28.56
|
| Rate for Payer: PHCS PPO |
$31.10
|
| Rate for Payer: PHCS PPO |
$54.77
|
| Rate for Payer: Three Rivers PPO |
$23.80
|
| Rate for Payer: Three Rivers PPO |
$41.92
|
| Rate for Payer: TriWest Veterans Administration |
$32.42
|
| Rate for Payer: TriWest Veterans Administration |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$27.61
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
| Rate for Payer: United Healthcare Medicare |
$32.42
|
| Rate for Payer: United Healthcare Medicare |
$18.40
|
| Rate for Payer: WINHealth Partners Commercial |
$31.10
|
| Rate for Payer: WINHealth Partners Commercial |
$54.77
|
| Rate for Payer: Wise Provider Network Commercial |
$30.14
|
| Rate for Payer: Wise Provider Network Commercial |
$53.10
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [13108]
|
Facility
|
IP
|
$55.89
|
|
|
Service Code
|
HCPCS J1817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$55.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.77
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.46
|
| Rate for Payer: Altius Commercial |
$30.46
|
| Rate for Payer: Altius Commercial |
$53.65
|
| Rate for Payer: Beech Street Commercial |
$54.77
|
| Rate for Payer: Beech Street Commercial |
$31.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.89
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.21
|
| Rate for Payer: Cigna of WY Commercial |
$54.77
|
| Rate for Payer: Cigna of WY Commercial |
$31.10
|
| Rate for Payer: Entrust Commercial |
$30.14
|
| Rate for Payer: Entrust Commercial |
$53.10
|
| Rate for Payer: First Choice Health Commercial |
$30.14
|
| Rate for Payer: First Choice Health Commercial |
$53.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.94
|
| Rate for Payer: HealthUtah PPO |
$55.89
|
| Rate for Payer: HealthUtah PPO |
$31.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.21
|
| Rate for Payer: Multiplan Medicare/VA |
$35.04
|
| Rate for Payer: Multiplan Medicare/VA |
$19.89
|
| Rate for Payer: One Health Plan of WY PPO |
$54.77
|
| Rate for Payer: One Health Plan of WY PPO |
$31.10
|
| Rate for Payer: PacificSource Commercial |
$50.30
|
| Rate for Payer: PacificSource Commercial |
$28.56
|
| Rate for Payer: PHCS PPO |
$31.10
|
| Rate for Payer: PHCS PPO |
$54.77
|
| Rate for Payer: Three Rivers PPO |
$23.80
|
| Rate for Payer: Three Rivers PPO |
$41.92
|
| Rate for Payer: TriWest Veterans Administration |
$36.89
|
| Rate for Payer: TriWest Veterans Administration |
$20.94
|
| Rate for Payer: United Healthcare Commercial |
$27.61
|
| Rate for Payer: United Healthcare Commercial |
$48.62
|
| Rate for Payer: United Healthcare Medicare |
$36.89
|
| Rate for Payer: United Healthcare Medicare |
$20.94
|
| Rate for Payer: WINHealth Partners Commercial |
$30.14
|
| Rate for Payer: WINHealth Partners Commercial |
$53.10
|
| Rate for Payer: Wise Provider Network Commercial |
$30.14
|
| Rate for Payer: Wise Provider Network Commercial |
$53.10
|
|
|
INTERJECT CONTR NEED 240C
|
Facility
|
OP
|
$101.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.47
|
| Rate for Payer: Aetna of WY Medicare |
$66.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.44
|
| Rate for Payer: Altius Commercial |
$97.44
|
| Rate for Payer: Beech Street Commercial |
$99.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.33
|
| Rate for Payer: Cash Price |
$71.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.46
|
| Rate for Payer: Cigna of WY Commercial |
$99.47
|
| Rate for Payer: Entrust Commercial |
$96.42
|
| Rate for Payer: First Choice Health Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.87
|
| Rate for Payer: HealthUtah PPO |
$101.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.46
|
| Rate for Payer: Multiplan Medicare/VA |
$55.93
|
| Rate for Payer: One Health Plan of WY PPO |
$99.47
|
| Rate for Payer: PacificSource Commercial |
$91.35
|
| Rate for Payer: PHCS PPO |
$99.47
|
| Rate for Payer: Three Rivers PPO |
$76.12
|
| Rate for Payer: TriWest Veterans Administration |
$58.87
|
| Rate for Payer: United Healthcare Commercial |
$88.30
|
| Rate for Payer: United Healthcare Medicare |
$58.87
|
| Rate for Payer: WINHealth Partners Commercial |
$99.47
|
| Rate for Payer: Wise Provider Network Commercial |
$96.42
|
|
|
INTERJECT CONTR NEED 240C
|
Facility
|
IP
|
$101.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.44
|
| Rate for Payer: Altius Commercial |
$97.44
|
| Rate for Payer: Beech Street Commercial |
$99.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.33
|
| Rate for Payer: Cash Price |
$71.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.46
|
| Rate for Payer: Cigna of WY Commercial |
$99.47
|
| Rate for Payer: Entrust Commercial |
$96.42
|
| Rate for Payer: First Choice Health Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.99
|
| Rate for Payer: HealthUtah PPO |
$101.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.46
|
| Rate for Payer: Multiplan Medicare/VA |
$63.64
|
| Rate for Payer: One Health Plan of WY PPO |
$99.47
|
| Rate for Payer: PacificSource Commercial |
$91.35
|
| Rate for Payer: PHCS PPO |
$99.47
|
| Rate for Payer: Three Rivers PPO |
$76.12
|
| Rate for Payer: TriWest Veterans Administration |
$66.99
|
| Rate for Payer: United Healthcare Commercial |
$88.30
|
| Rate for Payer: United Healthcare Medicare |
$66.99
|
| Rate for Payer: WINHealth Partners Commercial |
$96.42
|
| Rate for Payer: Wise Provider Network Commercial |
$96.42
|
|
|
INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 22841
|
| Hospital Charge Code |
22841
|
| Min. Negotiated Rate |
$977.25 |
| Max. Negotiated Rate |
$1,303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,276.94
|
| Rate for Payer: Beech Street Commercial |
$1,237.85
|
| Rate for Payer: Cash Price |
$912.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,263.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,276.94
|
| Rate for Payer: First Choice Health Commercial |
$1,172.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,237.85
|
| Rate for Payer: HealthUtah PPO |
$1,303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,263.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,276.94
|
| Rate for Payer: PacificSource Commercial |
$1,172.70
|
| Rate for Payer: PHCS PPO |
$1,237.85
|
| Rate for Payer: Three Rivers PPO |
$977.25
|
| Rate for Payer: United Healthcare Commercial |
$1,133.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.55
|
|
|
INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 93288
|
| Hospital Charge Code |
93288
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Aetna of WY Medicare |
$54.84
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: First Choice Health Commercial |
$216.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.84
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$46.61
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.84
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$54.84
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
|
|
INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$7,158.00
|
|
|
Service Code
|
HCPCS 23900
|
| Hospital Charge Code |
23900
|
| Min. Negotiated Rate |
$1,129.25 |
| Max. Negotiated Rate |
$7,158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,014.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,328.53
|
| Rate for Payer: Beech Street Commercial |
$6,800.10
|
| Rate for Payer: Cash Price |
$5,010.60
|
| Rate for Payer: Cash Price |
$5,010.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,943.26
|
| Rate for Payer: Cigna of WY Commercial |
$7,014.84
|
| Rate for Payer: First Choice Health Commercial |
$6,442.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,800.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,328.53
|
| Rate for Payer: HealthUtah PPO |
$7,158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,943.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,129.25
|
| Rate for Payer: One Health Plan of WY PPO |
$7,014.84
|
| Rate for Payer: PacificSource Commercial |
$6,442.20
|
| Rate for Payer: PHCS PPO |
$6,800.10
|
| Rate for Payer: Three Rivers PPO |
$5,368.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,328.53
|
| Rate for Payer: United Healthcare Commercial |
$6,227.46
|
| Rate for Payer: United Healthcare Medicare |
$1,328.53
|
| Rate for Payer: WINHealth Partners Commercial |
$6,084.30
|
|
|
INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
46945
|
| Min. Negotiated Rate |
$281.61 |
| Max. Negotiated Rate |
$1,729.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,694.42
|
| Rate for Payer: Aetna of WY Medicare |
$331.31
|
| Rate for Payer: Beech Street Commercial |
$1,642.55
|
| Rate for Payer: Cash Price |
$1,210.30
|
| Rate for Payer: Cash Price |
$1,210.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,677.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,694.42
|
| Rate for Payer: First Choice Health Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,642.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.31
|
| Rate for Payer: HealthUtah PPO |
$1,729.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,677.13
|
| Rate for Payer: Multiplan Medicare/VA |
$281.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,694.42
|
| Rate for Payer: PacificSource Commercial |
$1,556.10
|
| Rate for Payer: PHCS PPO |
$1,642.55
|
| Rate for Payer: Three Rivers PPO |
$1,296.75
|
| Rate for Payer: TriWest Veterans Administration |
$331.31
|
| Rate for Payer: United Healthcare Commercial |
$1,504.23
|
| Rate for Payer: United Healthcare Medicare |
$331.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,469.65
|
|
|
INTRA ABDOMINAL PRESSURE KIT
|
Facility
|
OP
|
$383.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$383.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$375.82
|
| Rate for Payer: Aetna of WY Medicare |
$253.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$368.15
|
| Rate for Payer: Altius Commercial |
$368.15
|
| Rate for Payer: Beech Street Commercial |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.85
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$371.99
|
| Rate for Payer: Cigna of WY Commercial |
$375.82
|
| Rate for Payer: Entrust Commercial |
$364.32
|
| Rate for Payer: First Choice Health Commercial |
$364.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.42
|
| Rate for Payer: HealthUtah PPO |
$383.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$371.99
|
| Rate for Payer: Multiplan Medicare/VA |
$211.30
|
| Rate for Payer: One Health Plan of WY PPO |
$375.82
|
| Rate for Payer: PacificSource Commercial |
$345.14
|
| Rate for Payer: PHCS PPO |
$375.82
|
| Rate for Payer: Three Rivers PPO |
$287.62
|
| Rate for Payer: TriWest Veterans Administration |
$222.42
|
| Rate for Payer: United Healthcare Commercial |
$333.64
|
| Rate for Payer: United Healthcare Medicare |
$222.42
|
| Rate for Payer: WINHealth Partners Commercial |
$375.82
|
| Rate for Payer: Wise Provider Network Commercial |
$364.32
|
|
|
INTRA ABDOMINAL PRESSURE KIT
|
Facility
|
IP
|
$383.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.45 |
| Max. Negotiated Rate |
$383.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$375.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$368.15
|
| Rate for Payer: Altius Commercial |
$368.15
|
| Rate for Payer: Beech Street Commercial |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.85
|
| Rate for Payer: Cash Price |
$268.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$371.99
|
| Rate for Payer: Cigna of WY Commercial |
$375.82
|
| Rate for Payer: Entrust Commercial |
$364.32
|
| Rate for Payer: First Choice Health Commercial |
$364.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.10
|
| Rate for Payer: HealthUtah PPO |
$383.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$371.99
|
| Rate for Payer: Multiplan Medicare/VA |
$240.45
|
| Rate for Payer: One Health Plan of WY PPO |
$375.82
|
| Rate for Payer: PacificSource Commercial |
$345.14
|
| Rate for Payer: PHCS PPO |
$375.82
|
| Rate for Payer: Three Rivers PPO |
$287.62
|
| Rate for Payer: TriWest Veterans Administration |
$253.10
|
| Rate for Payer: United Healthcare Commercial |
$333.64
|
| Rate for Payer: United Healthcare Medicare |
$253.10
|
| Rate for Payer: WINHealth Partners Commercial |
$364.32
|
| Rate for Payer: Wise Provider Network Commercial |
$364.32
|
|
|
INTRAOP KINETIC BALANCE SENSR KNEE RPLCMT ARTHRP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 0396T
|
| Hospital Charge Code |
0396T
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$1,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,295.56
|
| Rate for Payer: Beech Street Commercial |
$1,255.90
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,282.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,295.56
|
| Rate for Payer: First Choice Health Commercial |
$1,189.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,255.90
|
| Rate for Payer: HealthUtah PPO |
$1,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,282.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,295.56
|
| Rate for Payer: PacificSource Commercial |
$1,189.80
|
| Rate for Payer: PHCS PPO |
$1,255.90
|
| Rate for Payer: Three Rivers PPO |
$991.50
|
| Rate for Payer: United Healthcare Commercial |
$1,150.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,255.90
|
|
