|
LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,667.00
|
|
|
Service Code
|
HCPCS 63042 AS
|
| Hospital Charge Code |
63042
|
| Min. Negotiated Rate |
$1,052.64 |
| Max. Negotiated Rate |
$6,667.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,533.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,238.40
|
| Rate for Payer: Beech Street Commercial |
$6,333.65
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,466.99
|
| Rate for Payer: Cigna of WY Commercial |
$6,533.66
|
| Rate for Payer: First Choice Health Commercial |
$6,000.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,333.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,238.40
|
| Rate for Payer: HealthUtah PPO |
$6,667.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,466.99
|
| Rate for Payer: Multiplan Medicare/VA |
$1,052.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,533.66
|
| Rate for Payer: PacificSource Commercial |
$6,000.30
|
| Rate for Payer: PHCS PPO |
$6,333.65
|
| Rate for Payer: Three Rivers PPO |
$5,000.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,238.40
|
| Rate for Payer: United Healthcare Commercial |
$5,800.29
|
| Rate for Payer: United Healthcare Medicare |
$1,238.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,666.95
|
|
|
LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$6,667.00
|
|
|
Service Code
|
HCPCS 63042
|
| Hospital Charge Code |
63042
|
| Min. Negotiated Rate |
$1,052.64 |
| Max. Negotiated Rate |
$6,667.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,533.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,238.40
|
| Rate for Payer: Beech Street Commercial |
$6,333.65
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: Cash Price |
$4,666.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,466.99
|
| Rate for Payer: Cigna of WY Commercial |
$6,533.66
|
| Rate for Payer: First Choice Health Commercial |
$6,000.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,333.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,238.40
|
| Rate for Payer: HealthUtah PPO |
$6,667.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,466.99
|
| Rate for Payer: Multiplan Medicare/VA |
$1,052.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,533.66
|
| Rate for Payer: PacificSource Commercial |
$6,000.30
|
| Rate for Payer: PHCS PPO |
$6,333.65
|
| Rate for Payer: Three Rivers PPO |
$5,000.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,238.40
|
| Rate for Payer: United Healthcare Commercial |
$5,800.29
|
| Rate for Payer: United Healthcare Medicare |
$1,238.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,666.95
|
|
|
LAMOTRIGINE 100 MG TABLET [19451]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 6808431901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
LAMOTRIGINE 100 MG TABLET [19451]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
NDC 6808431911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Aetna of WY Medicare |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
LAMOTRIGINE 100 MG TABLET [19451]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 6808431911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
LAMOTRIGINE 100 MG TABLET [19451]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
NDC 6808431901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Aetna of WY Medicare |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
LAMOTRIGINE 25 MG TABLET [8514]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 6808431801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Aetna of WY Medicare |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.43
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.41
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.43
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
LAMOTRIGINE 25 MG TABLET [8514]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 6808431801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.70
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
LAMOTRIGINE 25 MG TABLET [8514]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 6808431811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Aetna of WY Medicare |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.43
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.41
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.43
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
LAMOTRIGINE 25 MG TABLET [8514]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 6808431811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.70
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
LANCETS [9849]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 7553700971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
LANCETS [9849]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 7553700971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
LANCETS [9849]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 5092497110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Aetna of WY Medicare |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.26
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.47
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
LANCETS [9849]
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 5092497110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.46
|
| Rate for Payer: Beech Street Commercial |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.47
|
| Rate for Payer: Cigna of WY Commercial |
$0.47
|
| Rate for Payer: Entrust Commercial |
$0.46
|
| Rate for Payer: First Choice Health Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.47
|
| Rate for Payer: PacificSource Commercial |
$0.43
|
| Rate for Payer: PHCS PPO |
$0.47
|
| Rate for Payer: Three Rivers PPO |
$0.36
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.42
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.46
|
| Rate for Payer: Wise Provider Network Commercial |
$0.46
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [54140]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 7214000021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM [54140]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 7214000021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [45365]
|
Facility
|
OP
|
$26,692.98
|
|
|
Service Code
|
HCPCS J1932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,707.83 |
| Max. Negotiated Rate |
$26,692.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26,159.12
|
| Rate for Payer: Aetna of WY Medicare |
$17,617.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25,625.26
|
| Rate for Payer: Altius Commercial |
$25,625.26
|
| Rate for Payer: Beech Street Commercial |
$26,159.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,914.94
|
| Rate for Payer: Cash Price |
$18,685.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$25,892.19
|
| Rate for Payer: Cigna of WY Commercial |
$26,159.12
|
| Rate for Payer: Entrust Commercial |
$25,358.33
|
| Rate for Payer: First Choice Health Commercial |
$25,358.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25,358.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15,481.93
|
| Rate for Payer: HealthUtah PPO |
$26,692.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25,892.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14,707.83
|
| Rate for Payer: One Health Plan of WY PPO |
$26,159.12
|
| Rate for Payer: PacificSource Commercial |
$24,023.68
|
| Rate for Payer: PHCS PPO |
$26,159.12
|
| Rate for Payer: Three Rivers PPO |
$20,019.74
|
| Rate for Payer: TriWest Veterans Administration |
$15,481.93
|
| Rate for Payer: United Healthcare Commercial |
$23,222.89
|
| Rate for Payer: United Healthcare Medicare |
$15,481.93
|
| Rate for Payer: WINHealth Partners Commercial |
$26,159.12
|
| Rate for Payer: Wise Provider Network Commercial |
$25,358.33
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [45365]
|
Facility
|
IP
|
$26,692.98
|
|
|
Service Code
|
HCPCS J1932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,736.50 |
| Max. Negotiated Rate |
$26,692.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26,159.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25,625.26
|
| Rate for Payer: Altius Commercial |
$25,625.26
|
| Rate for Payer: Beech Street Commercial |
$26,159.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21,914.94
|
| Rate for Payer: Cash Price |
$18,685.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$25,892.19
|
| Rate for Payer: Cigna of WY Commercial |
$26,159.12
|
| Rate for Payer: Entrust Commercial |
$25,358.33
|
| Rate for Payer: First Choice Health Commercial |
$25,358.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25,358.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17,617.37
|
| Rate for Payer: HealthUtah PPO |
$26,692.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25,892.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16,736.50
|
| Rate for Payer: One Health Plan of WY PPO |
$26,159.12
|
| Rate for Payer: PacificSource Commercial |
$24,023.68
|
| Rate for Payer: PHCS PPO |
$26,159.12
|
| Rate for Payer: Three Rivers PPO |
$20,019.74
|
| Rate for Payer: TriWest Veterans Administration |
$17,617.37
|
| Rate for Payer: United Healthcare Commercial |
$23,222.89
|
| Rate for Payer: United Healthcare Medicare |
$17,617.37
|
| Rate for Payer: WINHealth Partners Commercial |
$25,358.33
|
| Rate for Payer: Wise Provider Network Commercial |
$25,358.33
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [45365]
|
Facility
|
OP
|
$28,701.00
|
|
|
Service Code
|
HCPCS J1930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,814.25 |
| Max. Negotiated Rate |
$28,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28,126.98
|
| Rate for Payer: Aetna of WY Medicare |
$18,942.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27,552.96
|
| Rate for Payer: Altius Commercial |
$27,552.96
|
| Rate for Payer: Beech Street Commercial |
$28,126.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23,563.52
|
| Rate for Payer: Cash Price |
$20,090.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$27,839.97
|
| Rate for Payer: Cigna of WY Commercial |
$28,126.98
|
| Rate for Payer: Entrust Commercial |
$27,265.95
|
| Rate for Payer: First Choice Health Commercial |
$27,265.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27,265.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16,646.58
|
| Rate for Payer: HealthUtah PPO |
$28,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27,839.97
|
| Rate for Payer: Multiplan Medicare/VA |
$15,814.25
|
| Rate for Payer: One Health Plan of WY PPO |
$28,126.98
|
| Rate for Payer: PacificSource Commercial |
$25,830.90
|
| Rate for Payer: PHCS PPO |
$28,126.98
|
| Rate for Payer: Three Rivers PPO |
$21,525.75
|
| Rate for Payer: TriWest Veterans Administration |
$16,646.58
|
| Rate for Payer: United Healthcare Commercial |
$24,969.87
|
| Rate for Payer: United Healthcare Medicare |
$16,646.58
|
| Rate for Payer: WINHealth Partners Commercial |
$28,126.98
|
| Rate for Payer: Wise Provider Network Commercial |
$27,265.95
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE [45365]
|
Facility
|
IP
|
$28,701.00
|
|
|
Service Code
|
HCPCS J1930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,995.53 |
| Max. Negotiated Rate |
$28,701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28,126.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27,552.96
|
| Rate for Payer: Altius Commercial |
$27,552.96
|
| Rate for Payer: Beech Street Commercial |
$28,126.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23,563.52
|
| Rate for Payer: Cash Price |
$20,090.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$27,839.97
|
| Rate for Payer: Cigna of WY Commercial |
$28,126.98
|
| Rate for Payer: Entrust Commercial |
$27,265.95
|
| Rate for Payer: First Choice Health Commercial |
$27,265.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27,265.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18,942.66
|
| Rate for Payer: HealthUtah PPO |
$28,701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27,839.97
|
| Rate for Payer: Multiplan Medicare/VA |
$17,995.53
|
| Rate for Payer: One Health Plan of WY PPO |
$28,126.98
|
| Rate for Payer: PacificSource Commercial |
$25,830.90
|
| Rate for Payer: PHCS PPO |
$28,126.98
|
| Rate for Payer: Three Rivers PPO |
$21,525.75
|
| Rate for Payer: TriWest Veterans Administration |
$18,942.66
|
| Rate for Payer: United Healthcare Commercial |
$24,969.87
|
| Rate for Payer: United Healthcare Medicare |
$18,942.66
|
| Rate for Payer: WINHealth Partners Commercial |
$27,265.95
|
| Rate for Payer: Wise Provider Network Commercial |
$27,265.95
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [45364]
|
Facility
|
OP
|
$40,555.00
|
|
|
Service Code
|
HCPCS J1930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,345.80 |
| Max. Negotiated Rate |
$40,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39,743.90
|
| Rate for Payer: Aetna of WY Medicare |
$26,766.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38,932.80
|
| Rate for Payer: Altius Commercial |
$38,932.80
|
| Rate for Payer: Beech Street Commercial |
$39,743.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33,295.66
|
| Rate for Payer: Cash Price |
$28,388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$39,338.35
|
| Rate for Payer: Cigna of WY Commercial |
$39,743.90
|
| Rate for Payer: Entrust Commercial |
$38,527.25
|
| Rate for Payer: First Choice Health Commercial |
$38,527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38,527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23,521.90
|
| Rate for Payer: HealthUtah PPO |
$40,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39,338.35
|
| Rate for Payer: Multiplan Medicare/VA |
$22,345.80
|
| Rate for Payer: One Health Plan of WY PPO |
$39,743.90
|
| Rate for Payer: PacificSource Commercial |
$36,499.50
|
| Rate for Payer: PHCS PPO |
$39,743.90
|
| Rate for Payer: Three Rivers PPO |
$30,416.25
|
| Rate for Payer: TriWest Veterans Administration |
$23,521.90
|
| Rate for Payer: United Healthcare Commercial |
$35,282.85
|
| Rate for Payer: United Healthcare Medicare |
$23,521.90
|
| Rate for Payer: WINHealth Partners Commercial |
$39,743.90
|
| Rate for Payer: Wise Provider Network Commercial |
$38,527.25
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE [45364]
|
Facility
|
IP
|
$40,555.00
|
|
|
Service Code
|
HCPCS J1930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25,427.98 |
| Max. Negotiated Rate |
$40,555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39,743.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38,932.80
|
| Rate for Payer: Altius Commercial |
$38,932.80
|
| Rate for Payer: Beech Street Commercial |
$39,743.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33,295.66
|
| Rate for Payer: Cash Price |
$28,388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$39,338.35
|
| Rate for Payer: Cigna of WY Commercial |
$39,743.90
|
| Rate for Payer: Entrust Commercial |
$38,527.25
|
| Rate for Payer: First Choice Health Commercial |
$38,527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38,527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26,766.30
|
| Rate for Payer: HealthUtah PPO |
$40,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39,338.35
|
| Rate for Payer: Multiplan Medicare/VA |
$25,427.98
|
| Rate for Payer: One Health Plan of WY PPO |
$39,743.90
|
| Rate for Payer: PacificSource Commercial |
$36,499.50
|
| Rate for Payer: PHCS PPO |
$39,743.90
|
| Rate for Payer: Three Rivers PPO |
$30,416.25
|
| Rate for Payer: TriWest Veterans Administration |
$26,766.30
|
| Rate for Payer: United Healthcare Commercial |
$35,282.85
|
| Rate for Payer: United Healthcare Medicare |
$26,766.30
|
| Rate for Payer: WINHealth Partners Commercial |
$38,527.25
|
| Rate for Payer: Wise Provider Network Commercial |
$38,527.25
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$3,112.00
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
44970
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.76
|
| Rate for Payer: Aetna of WY Medicare |
$575.29
|
| Rate for Payer: Beech Street Commercial |
$2,956.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.76
|
| Rate for Payer: First Choice Health Commercial |
$2,800.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,956.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$575.29
|
| Rate for Payer: HealthUtah PPO |
$3,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.64
|
| Rate for Payer: Multiplan Medicare/VA |
$489.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.76
|
| Rate for Payer: PacificSource Commercial |
$2,800.80
|
| Rate for Payer: PHCS PPO |
$2,956.40
|
| Rate for Payer: Three Rivers PPO |
$2,334.00
|
| Rate for Payer: TriWest Veterans Administration |
$575.29
|
| Rate for Payer: United Healthcare Commercial |
$2,707.44
|
| Rate for Payer: United Healthcare Medicare |
$575.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,645.20
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$3,112.00
|
|
|
Service Code
|
HCPCS 44970 AS
|
| Hospital Charge Code |
44970
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.76
|
| Rate for Payer: Aetna of WY Medicare |
$575.29
|
| Rate for Payer: Beech Street Commercial |
$2,956.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.76
|
| Rate for Payer: First Choice Health Commercial |
$2,800.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,956.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$575.29
|
| Rate for Payer: HealthUtah PPO |
$3,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.64
|
| Rate for Payer: Multiplan Medicare/VA |
$489.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.76
|
| Rate for Payer: PacificSource Commercial |
$2,800.80
|
| Rate for Payer: PHCS PPO |
$2,956.40
|
| Rate for Payer: Three Rivers PPO |
$2,334.00
|
| Rate for Payer: TriWest Veterans Administration |
$575.29
|
| Rate for Payer: United Healthcare Commercial |
$2,707.44
|
| Rate for Payer: United Healthcare Medicare |
$575.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,645.20
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Professional
|
Both
|
$3,112.00
|
|
|
Service Code
|
HCPCS 44970 80
|
| Hospital Charge Code |
44970
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,049.76
|
| Rate for Payer: Aetna of WY Medicare |
$575.29
|
| Rate for Payer: Beech Street Commercial |
$2,956.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,018.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,049.76
|
| Rate for Payer: First Choice Health Commercial |
$2,800.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,956.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$575.29
|
| Rate for Payer: HealthUtah PPO |
$3,112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,018.64
|
| Rate for Payer: Multiplan Medicare/VA |
$489.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,049.76
|
| Rate for Payer: PacificSource Commercial |
$2,800.80
|
| Rate for Payer: PHCS PPO |
$2,956.40
|
| Rate for Payer: Three Rivers PPO |
$2,334.00
|
| Rate for Payer: TriWest Veterans Administration |
$575.29
|
| Rate for Payer: United Healthcare Commercial |
$2,707.44
|
| Rate for Payer: United Healthcare Medicare |
$575.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,645.20
|
|
