|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
IP
|
$11.78
|
|
|
Service Code
|
NDC 1011953708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.31
|
| Rate for Payer: Altius Commercial |
$11.31
|
| Rate for Payer: Beech Street Commercial |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.43
|
| Rate for Payer: Cigna of WY Commercial |
$11.54
|
| Rate for Payer: Entrust Commercial |
$11.19
|
| Rate for Payer: First Choice Health Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$11.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.43
|
| Rate for Payer: Multiplan Medicare/VA |
$7.39
|
| Rate for Payer: One Health Plan of WY PPO |
$11.54
|
| Rate for Payer: PacificSource Commercial |
$10.60
|
| Rate for Payer: PHCS PPO |
$11.54
|
| Rate for Payer: Three Rivers PPO |
$8.84
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$11.19
|
| Rate for Payer: Wise Provider Network Commercial |
$11.19
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
OP
|
$11.78
|
|
|
Service Code
|
NDC 2420853708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.54
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.31
|
| Rate for Payer: Altius Commercial |
$11.31
|
| Rate for Payer: Beech Street Commercial |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.43
|
| Rate for Payer: Cigna of WY Commercial |
$11.54
|
| Rate for Payer: Entrust Commercial |
$11.19
|
| Rate for Payer: First Choice Health Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.83
|
| Rate for Payer: HealthUtah PPO |
$11.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.43
|
| Rate for Payer: Multiplan Medicare/VA |
$6.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.54
|
| Rate for Payer: PacificSource Commercial |
$10.60
|
| Rate for Payer: PHCS PPO |
$11.54
|
| Rate for Payer: Three Rivers PPO |
$8.84
|
| Rate for Payer: TriWest Veterans Administration |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$6.83
|
| Rate for Payer: WINHealth Partners Commercial |
$11.54
|
| Rate for Payer: Wise Provider Network Commercial |
$11.19
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
IP
|
$11.78
|
|
|
Service Code
|
NDC 2420853708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.31
|
| Rate for Payer: Altius Commercial |
$11.31
|
| Rate for Payer: Beech Street Commercial |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.43
|
| Rate for Payer: Cigna of WY Commercial |
$11.54
|
| Rate for Payer: Entrust Commercial |
$11.19
|
| Rate for Payer: First Choice Health Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$11.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.43
|
| Rate for Payer: Multiplan Medicare/VA |
$7.39
|
| Rate for Payer: One Health Plan of WY PPO |
$11.54
|
| Rate for Payer: PacificSource Commercial |
$10.60
|
| Rate for Payer: PHCS PPO |
$11.54
|
| Rate for Payer: Three Rivers PPO |
$8.84
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$11.19
|
| Rate for Payer: Wise Provider Network Commercial |
$11.19
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
OP
|
$11.78
|
|
|
Service Code
|
NDC 1011953708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.54
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.31
|
| Rate for Payer: Altius Commercial |
$11.31
|
| Rate for Payer: Beech Street Commercial |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.43
|
| Rate for Payer: Cigna of WY Commercial |
$11.54
|
| Rate for Payer: Entrust Commercial |
$11.19
|
| Rate for Payer: First Choice Health Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.83
|
| Rate for Payer: HealthUtah PPO |
$11.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.43
|
| Rate for Payer: Multiplan Medicare/VA |
$6.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.54
|
| Rate for Payer: PacificSource Commercial |
$10.60
|
| Rate for Payer: PHCS PPO |
$11.54
|
| Rate for Payer: Three Rivers PPO |
$8.84
|
| Rate for Payer: TriWest Veterans Administration |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$10.25
|
| Rate for Payer: United Healthcare Medicare |
$6.83
|
| Rate for Payer: WINHealth Partners Commercial |
$11.54
|
| Rate for Payer: Wise Provider Network Commercial |
$11.19
|
|
|
BRIMONIDINE 0.2 % EYE DROPS [13720]
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 7006923101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.79
|
| Rate for Payer: Aetna of WY Medicare |
$3.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.69
|
| Rate for Payer: Altius Commercial |
$4.69
|
| Rate for Payer: Beech Street Commercial |
$4.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.74
|
| Rate for Payer: Cigna of WY Commercial |
$4.79
|
| Rate for Payer: Entrust Commercial |
$4.65
|
| Rate for Payer: First Choice Health Commercial |
$4.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.74
|
| Rate for Payer: Multiplan Medicare/VA |
$2.69
|
| Rate for Payer: One Health Plan of WY PPO |
$4.79
|
| Rate for Payer: PacificSource Commercial |
$4.40
|
| Rate for Payer: PHCS PPO |
$4.79
|
| Rate for Payer: Three Rivers PPO |
$3.67
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.79
|
| Rate for Payer: Wise Provider Network Commercial |
$4.65
|
|
|
BRIMONIDINE 0.2 % EYE DROPS [13720]
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 7006923101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.69
|
| Rate for Payer: Altius Commercial |
$4.69
|
| Rate for Payer: Beech Street Commercial |
$4.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.74
|
| Rate for Payer: Cigna of WY Commercial |
$4.79
|
| Rate for Payer: Entrust Commercial |
$4.65
|
| Rate for Payer: First Choice Health Commercial |
$4.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.23
|
| Rate for Payer: HealthUtah PPO |
$4.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.74
|
| Rate for Payer: Multiplan Medicare/VA |
$3.07
|
| Rate for Payer: One Health Plan of WY PPO |
$4.79
|
| Rate for Payer: PacificSource Commercial |
$4.40
|
| Rate for Payer: PHCS PPO |
$4.79
|
| Rate for Payer: Three Rivers PPO |
$3.67
|
| Rate for Payer: TriWest Veterans Administration |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Medicare |
$3.23
|
| Rate for Payer: WINHealth Partners Commercial |
$4.65
|
| Rate for Payer: Wise Provider Network Commercial |
$4.65
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION [4392]
|
Facility
|
IP
|
$61.71
|
|
|
Service Code
|
NDC 6868246410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.24
|
| Rate for Payer: Altius Commercial |
$59.24
|
| Rate for Payer: Beech Street Commercial |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.86
|
| Rate for Payer: Cigna of WY Commercial |
$60.48
|
| Rate for Payer: Entrust Commercial |
$58.62
|
| Rate for Payer: First Choice Health Commercial |
$58.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.73
|
| Rate for Payer: HealthUtah PPO |
$61.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.86
|
| Rate for Payer: Multiplan Medicare/VA |
$38.69
|
| Rate for Payer: One Health Plan of WY PPO |
$60.48
|
| Rate for Payer: PacificSource Commercial |
$55.54
|
| Rate for Payer: PHCS PPO |
$60.48
|
| Rate for Payer: Three Rivers PPO |
$46.28
|
| Rate for Payer: TriWest Veterans Administration |
$40.73
|
| Rate for Payer: United Healthcare Commercial |
$53.69
|
| Rate for Payer: United Healthcare Medicare |
$40.73
|
| Rate for Payer: WINHealth Partners Commercial |
$58.62
|
| Rate for Payer: Wise Provider Network Commercial |
$58.62
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION [4392]
|
Facility
|
OP
|
$61.71
|
|
|
Service Code
|
NDC 6868246410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.48
|
| Rate for Payer: Aetna of WY Medicare |
$40.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.24
|
| Rate for Payer: Altius Commercial |
$59.24
|
| Rate for Payer: Beech Street Commercial |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.86
|
| Rate for Payer: Cigna of WY Commercial |
$60.48
|
| Rate for Payer: Entrust Commercial |
$58.62
|
| Rate for Payer: First Choice Health Commercial |
$58.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.79
|
| Rate for Payer: HealthUtah PPO |
$61.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.86
|
| Rate for Payer: Multiplan Medicare/VA |
$34.00
|
| Rate for Payer: One Health Plan of WY PPO |
$60.48
|
| Rate for Payer: PacificSource Commercial |
$55.54
|
| Rate for Payer: PHCS PPO |
$60.48
|
| Rate for Payer: Three Rivers PPO |
$46.28
|
| Rate for Payer: TriWest Veterans Administration |
$35.79
|
| Rate for Payer: United Healthcare Commercial |
$53.69
|
| Rate for Payer: United Healthcare Medicare |
$35.79
|
| Rate for Payer: WINHealth Partners Commercial |
$60.48
|
| Rate for Payer: Wise Provider Network Commercial |
$58.62
|
|
|
BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 94060 26
|
| Hospital Charge Code |
94060
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Beech Street Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: First Choice Health Commercial |
$75.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$79.80
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
|
|
BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
31622
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$125.05
|
| Rate for Payer: Beech Street Commercial |
$1,157.10
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: First Choice Health Commercial |
$1,096.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.05
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$106.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,157.10
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.05
|
| Rate for Payer: United Healthcare Commercial |
$1,059.66
|
| Rate for Payer: United Healthcare Medicare |
$125.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,035.30
|
|
|
BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 94070 26
|
| Hospital Charge Code |
94070
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$26.35
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.35
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$22.40
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.35
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$26.35
|
| Rate for Payer: WINHealth Partners Commercial |
$167.20
|
|
|
BSMART ADAPTER NERVE BLOCK
|
Facility
|
IP
|
$36.28
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.83
|
| Rate for Payer: Altius Commercial |
$34.83
|
| Rate for Payer: Beech Street Commercial |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.79
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.19
|
| Rate for Payer: Cigna of WY Commercial |
$35.55
|
| Rate for Payer: Entrust Commercial |
$34.47
|
| Rate for Payer: First Choice Health Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.94
|
| Rate for Payer: HealthUtah PPO |
$36.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.19
|
| Rate for Payer: Multiplan Medicare/VA |
$22.75
|
| Rate for Payer: One Health Plan of WY PPO |
$35.55
|
| Rate for Payer: PacificSource Commercial |
$32.65
|
| Rate for Payer: PHCS PPO |
$35.55
|
| Rate for Payer: Three Rivers PPO |
$27.21
|
| Rate for Payer: TriWest Veterans Administration |
$23.94
|
| Rate for Payer: United Healthcare Commercial |
$31.56
|
| Rate for Payer: United Healthcare Medicare |
$23.94
|
| Rate for Payer: WINHealth Partners Commercial |
$34.47
|
| Rate for Payer: Wise Provider Network Commercial |
$34.47
|
|
|
BSMART ADAPTER NERVE BLOCK
|
Facility
|
OP
|
$36.28
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.55
|
| Rate for Payer: Aetna of WY Medicare |
$23.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.83
|
| Rate for Payer: Altius Commercial |
$34.83
|
| Rate for Payer: Beech Street Commercial |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.79
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.19
|
| Rate for Payer: Cigna of WY Commercial |
$35.55
|
| Rate for Payer: Entrust Commercial |
$34.47
|
| Rate for Payer: First Choice Health Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.04
|
| Rate for Payer: HealthUtah PPO |
$36.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.19
|
| Rate for Payer: Multiplan Medicare/VA |
$19.99
|
| Rate for Payer: One Health Plan of WY PPO |
$35.55
|
| Rate for Payer: PacificSource Commercial |
$32.65
|
| Rate for Payer: PHCS PPO |
$35.55
|
| Rate for Payer: Three Rivers PPO |
$27.21
|
| Rate for Payer: TriWest Veterans Administration |
$21.04
|
| Rate for Payer: United Healthcare Commercial |
$31.56
|
| Rate for Payer: United Healthcare Medicare |
$21.04
|
| Rate for Payer: WINHealth Partners Commercial |
$35.55
|
| Rate for Payer: Wise Provider Network Commercial |
$34.47
|
|
|
BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$8,975.00
|
|
|
Service Code
|
HCPCS 58954
|
| Hospital Charge Code |
58954
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$8,975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,795.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,081.55
|
| Rate for Payer: Beech Street Commercial |
$8,526.25
|
| Rate for Payer: Cash Price |
$6,282.50
|
| Rate for Payer: Cash Price |
$6,282.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,705.75
|
| Rate for Payer: Cigna of WY Commercial |
$8,795.50
|
| Rate for Payer: First Choice Health Commercial |
$8,077.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,526.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,081.55
|
| Rate for Payer: HealthUtah PPO |
$8,975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,705.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,769.32
|
| Rate for Payer: One Health Plan of WY PPO |
$8,795.50
|
| Rate for Payer: PacificSource Commercial |
$8,077.50
|
| Rate for Payer: PHCS PPO |
$8,526.25
|
| Rate for Payer: Three Rivers PPO |
$6,731.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,081.55
|
| Rate for Payer: United Healthcare Commercial |
$7,808.25
|
| Rate for Payer: United Healthcare Medicare |
$2,081.55
|
| Rate for Payer: WINHealth Partners Commercial |
$7,628.75
|
|
|
BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$8,282.00
|
|
|
Service Code
|
HCPCS 58953
|
| Hospital Charge Code |
58953
|
| Min. Negotiated Rate |
$1,635.69 |
| Max. Negotiated Rate |
$8,282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,116.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,924.34
|
| Rate for Payer: Beech Street Commercial |
$7,867.90
|
| Rate for Payer: Cash Price |
$5,797.40
|
| Rate for Payer: Cash Price |
$5,797.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,033.54
|
| Rate for Payer: Cigna of WY Commercial |
$8,116.36
|
| Rate for Payer: First Choice Health Commercial |
$7,453.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,867.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,924.34
|
| Rate for Payer: HealthUtah PPO |
$8,282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,033.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1,635.69
|
| Rate for Payer: One Health Plan of WY PPO |
$8,116.36
|
| Rate for Payer: PacificSource Commercial |
$7,453.80
|
| Rate for Payer: PHCS PPO |
$7,867.90
|
| Rate for Payer: Three Rivers PPO |
$6,211.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,924.34
|
| Rate for Payer: United Healthcare Commercial |
$7,205.34
|
| Rate for Payer: United Healthcare Medicare |
$1,924.34
|
| Rate for Payer: WINHealth Partners Commercial |
$7,039.70
|
|
|
BS RESOLUTION CLIP 235CM
|
Facility
|
IP
|
$542.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.15 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$531.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$520.80
|
| Rate for Payer: Altius Commercial |
$520.80
|
| Rate for Payer: Beech Street Commercial |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$445.39
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.22
|
| Rate for Payer: Cigna of WY Commercial |
$531.65
|
| Rate for Payer: Entrust Commercial |
$515.38
|
| Rate for Payer: First Choice Health Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.05
|
| Rate for Payer: HealthUtah PPO |
$542.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$340.15
|
| Rate for Payer: One Health Plan of WY PPO |
$531.65
|
| Rate for Payer: PacificSource Commercial |
$488.25
|
| Rate for Payer: PHCS PPO |
$531.65
|
| Rate for Payer: Three Rivers PPO |
$406.88
|
| Rate for Payer: TriWest Veterans Administration |
$358.05
|
| Rate for Payer: United Healthcare Commercial |
$471.98
|
| Rate for Payer: United Healthcare Medicare |
$358.05
|
| Rate for Payer: WINHealth Partners Commercial |
$515.38
|
| Rate for Payer: Wise Provider Network Commercial |
$515.38
|
|
|
BS RESOLUTION CLIP 235CM
|
Facility
|
OP
|
$542.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.92 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$531.65
|
| Rate for Payer: Aetna of WY Medicare |
$358.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$520.80
|
| Rate for Payer: Altius Commercial |
$520.80
|
| Rate for Payer: Beech Street Commercial |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$445.39
|
| Rate for Payer: Cash Price |
$379.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.22
|
| Rate for Payer: Cigna of WY Commercial |
$531.65
|
| Rate for Payer: Entrust Commercial |
$515.38
|
| Rate for Payer: First Choice Health Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.65
|
| Rate for Payer: HealthUtah PPO |
$542.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$298.92
|
| Rate for Payer: One Health Plan of WY PPO |
$531.65
|
| Rate for Payer: PacificSource Commercial |
$488.25
|
| Rate for Payer: PHCS PPO |
$531.65
|
| Rate for Payer: Three Rivers PPO |
$406.88
|
| Rate for Payer: TriWest Veterans Administration |
$314.65
|
| Rate for Payer: United Healthcare Commercial |
$471.98
|
| Rate for Payer: United Healthcare Medicare |
$314.65
|
| Rate for Payer: WINHealth Partners Commercial |
$531.65
|
| Rate for Payer: Wise Provider Network Commercial |
$515.38
|
|
|
BS SENSATION SHORT THROW SNARE
|
Facility
|
OP
|
$57.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.80
|
| Rate for Payer: Aetna of WY Medicare |
$38.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.64
|
| Rate for Payer: Altius Commercial |
$55.64
|
| Rate for Payer: Beech Street Commercial |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.59
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.22
|
| Rate for Payer: Cigna of WY Commercial |
$56.80
|
| Rate for Payer: Entrust Commercial |
$55.06
|
| Rate for Payer: First Choice Health Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.62
|
| Rate for Payer: HealthUtah PPO |
$57.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.22
|
| Rate for Payer: Multiplan Medicare/VA |
$31.94
|
| Rate for Payer: One Health Plan of WY PPO |
$56.80
|
| Rate for Payer: PacificSource Commercial |
$52.16
|
| Rate for Payer: PHCS PPO |
$56.80
|
| Rate for Payer: Three Rivers PPO |
$43.47
|
| Rate for Payer: TriWest Veterans Administration |
$33.62
|
| Rate for Payer: United Healthcare Commercial |
$50.43
|
| Rate for Payer: United Healthcare Medicare |
$33.62
|
| Rate for Payer: WINHealth Partners Commercial |
$56.80
|
| Rate for Payer: Wise Provider Network Commercial |
$55.06
|
|
|
BS SENSATION SHORT THROW SNARE
|
Facility
|
IP
|
$57.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.64
|
| Rate for Payer: Altius Commercial |
$55.64
|
| Rate for Payer: Beech Street Commercial |
$56.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.59
|
| Rate for Payer: Cash Price |
$40.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.22
|
| Rate for Payer: Cigna of WY Commercial |
$56.80
|
| Rate for Payer: Entrust Commercial |
$55.06
|
| Rate for Payer: First Choice Health Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.25
|
| Rate for Payer: HealthUtah PPO |
$57.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.22
|
| Rate for Payer: Multiplan Medicare/VA |
$36.34
|
| Rate for Payer: One Health Plan of WY PPO |
$56.80
|
| Rate for Payer: PacificSource Commercial |
$52.16
|
| Rate for Payer: PHCS PPO |
$56.80
|
| Rate for Payer: Three Rivers PPO |
$43.47
|
| Rate for Payer: TriWest Veterans Administration |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$50.43
|
| Rate for Payer: United Healthcare Medicare |
$38.25
|
| Rate for Payer: WINHealth Partners Commercial |
$55.06
|
| Rate for Payer: Wise Provider Network Commercial |
$55.06
|
|
|
BUCKS TRACTION
|
Facility
|
OP
|
$31.01
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.39
|
| Rate for Payer: Aetna of WY Medicare |
$20.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.77
|
| Rate for Payer: Altius Commercial |
$29.77
|
| Rate for Payer: Beech Street Commercial |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.46
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.08
|
| Rate for Payer: Cigna of WY Commercial |
$30.39
|
| Rate for Payer: Entrust Commercial |
$29.46
|
| Rate for Payer: First Choice Health Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.99
|
| Rate for Payer: HealthUtah PPO |
$31.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.08
|
| Rate for Payer: Multiplan Medicare/VA |
$17.09
|
| Rate for Payer: One Health Plan of WY PPO |
$30.39
|
| Rate for Payer: PacificSource Commercial |
$27.91
|
| Rate for Payer: PHCS PPO |
$30.39
|
| Rate for Payer: Three Rivers PPO |
$23.26
|
| Rate for Payer: TriWest Veterans Administration |
$17.99
|
| Rate for Payer: United Healthcare Commercial |
$26.98
|
| Rate for Payer: United Healthcare Medicare |
$17.99
|
| Rate for Payer: WINHealth Partners Commercial |
$30.39
|
| Rate for Payer: Wise Provider Network Commercial |
$29.46
|
|
|
BUCKS TRACTION
|
Facility
|
IP
|
$31.01
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.77
|
| Rate for Payer: Altius Commercial |
$29.77
|
| Rate for Payer: Beech Street Commercial |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.46
|
| Rate for Payer: Cash Price |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.08
|
| Rate for Payer: Cigna of WY Commercial |
$30.39
|
| Rate for Payer: Entrust Commercial |
$29.46
|
| Rate for Payer: First Choice Health Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.47
|
| Rate for Payer: HealthUtah PPO |
$31.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.08
|
| Rate for Payer: Multiplan Medicare/VA |
$19.44
|
| Rate for Payer: One Health Plan of WY PPO |
$30.39
|
| Rate for Payer: PacificSource Commercial |
$27.91
|
| Rate for Payer: PHCS PPO |
$30.39
|
| Rate for Payer: Three Rivers PPO |
$23.26
|
| Rate for Payer: TriWest Veterans Administration |
$20.47
|
| Rate for Payer: United Healthcare Commercial |
$26.98
|
| Rate for Payer: United Healthcare Medicare |
$20.47
|
| Rate for Payer: WINHealth Partners Commercial |
$29.46
|
| Rate for Payer: Wise Provider Network Commercial |
$29.46
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [15049]
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.31
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.52
|
| Rate for Payer: Aetna of WY Medicare |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$9.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.12
|
| Rate for Payer: Altius Commercial |
$9.12
|
| Rate for Payer: Altius Commercial |
$14.23
|
| Rate for Payer: Beech Street Commercial |
$14.52
|
| Rate for Payer: Beech Street Commercial |
$9.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.17
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.38
|
| Rate for Payer: Cigna of WY Commercial |
$14.52
|
| Rate for Payer: Cigna of WY Commercial |
$9.31
|
| Rate for Payer: Entrust Commercial |
$9.02
|
| Rate for Payer: Entrust Commercial |
$14.08
|
| Rate for Payer: First Choice Health Commercial |
$14.08
|
| Rate for Payer: First Choice Health Commercial |
$9.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.60
|
| Rate for Payer: HealthUtah PPO |
$14.82
|
| Rate for Payer: HealthUtah PPO |
$9.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.22
|
| Rate for Payer: Multiplan Medicare/VA |
$5.23
|
| Rate for Payer: Multiplan Medicare/VA |
$8.17
|
| Rate for Payer: One Health Plan of WY PPO |
$14.52
|
| Rate for Payer: One Health Plan of WY PPO |
$9.31
|
| Rate for Payer: PacificSource Commercial |
$8.55
|
| Rate for Payer: PacificSource Commercial |
$13.34
|
| Rate for Payer: PHCS PPO |
$14.52
|
| Rate for Payer: PHCS PPO |
$9.31
|
| Rate for Payer: Three Rivers PPO |
$11.12
|
| Rate for Payer: Three Rivers PPO |
$7.12
|
| Rate for Payer: TriWest Veterans Administration |
$5.51
|
| Rate for Payer: TriWest Veterans Administration |
$8.60
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Commercial |
$8.26
|
| Rate for Payer: United Healthcare Medicare |
$5.51
|
| Rate for Payer: United Healthcare Medicare |
$8.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$9.31
|
| Rate for Payer: Wise Provider Network Commercial |
$14.08
|
| Rate for Payer: Wise Provider Network Commercial |
$9.02
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION [15049]
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.31
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.23
|
| Rate for Payer: Altius Commercial |
$14.23
|
| Rate for Payer: Altius Commercial |
$9.12
|
| Rate for Payer: Beech Street Commercial |
$9.31
|
| Rate for Payer: Beech Street Commercial |
$14.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.22
|
| Rate for Payer: Cigna of WY Commercial |
$9.31
|
| Rate for Payer: Cigna of WY Commercial |
$14.52
|
| Rate for Payer: Entrust Commercial |
$14.08
|
| Rate for Payer: Entrust Commercial |
$9.02
|
| Rate for Payer: First Choice Health Commercial |
$14.08
|
| Rate for Payer: First Choice Health Commercial |
$9.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.78
|
| Rate for Payer: HealthUtah PPO |
$9.50
|
| Rate for Payer: HealthUtah PPO |
$14.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.22
|
| Rate for Payer: Multiplan Medicare/VA |
$5.96
|
| Rate for Payer: Multiplan Medicare/VA |
$9.29
|
| Rate for Payer: One Health Plan of WY PPO |
$9.31
|
| Rate for Payer: One Health Plan of WY PPO |
$14.52
|
| Rate for Payer: PacificSource Commercial |
$8.55
|
| Rate for Payer: PacificSource Commercial |
$13.34
|
| Rate for Payer: PHCS PPO |
$14.52
|
| Rate for Payer: PHCS PPO |
$9.31
|
| Rate for Payer: Three Rivers PPO |
$11.12
|
| Rate for Payer: Three Rivers PPO |
$7.12
|
| Rate for Payer: TriWest Veterans Administration |
$6.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.78
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Commercial |
$8.26
|
| Rate for Payer: United Healthcare Medicare |
$6.27
|
| Rate for Payer: United Healthcare Medicare |
$9.78
|
| Rate for Payer: WINHealth Partners Commercial |
$14.08
|
| Rate for Payer: WINHealth Partners Commercial |
$9.02
|
| Rate for Payer: Wise Provider Network Commercial |
$14.08
|
| Rate for Payer: Wise Provider Network Commercial |
$9.02
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [15228]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
636
|
| 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 Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$1.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.37
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| 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: Government Employees Health Association (GEHA) Medicare |
$10.15
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: TriWest Veterans Administration |
$10.15
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: United Healthcare Medicare |
$10.15
|
| Rate for Payer: WINHealth Partners Commercial |
$17.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.96
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION [15228]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.80
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| 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: Government Employees Health Association (GEHA) Medicare |
$11.55
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
