|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET [10269]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 5789663412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.10
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.10
|
| Rate for Payer: Altius Commercial |
$0.10
|
| Rate for Payer: Beech Street Commercial |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.10
|
| Rate for Payer: Cigna of WY Commercial |
$0.10
|
| 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 |
$0.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.10
|
| Rate for Payer: PacificSource Commercial |
$0.09
|
| Rate for Payer: PHCS PPO |
$0.10
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.09
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [46071]
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.65
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.06
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.91
|
| Rate for Payer: Cigna of WY Commercial |
$15.06
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: Entrust Commercial |
$14.60
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$15.37
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.91
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$15.06
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.83
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: PHCS PPO |
$15.06
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: Three Rivers PPO |
$11.53
|
| Rate for Payer: TriWest Veterans Administration |
$10.14
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Commercial |
$13.37
|
| Rate for Payer: United Healthcare Medicare |
$10.14
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$14.50
|
| Rate for Payer: WINHealth Partners Commercial |
$14.60
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.60
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK [46071]
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$10.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Beech Street Commercial |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.06
|
| Rate for Payer: Entrust Commercial |
$14.60
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.85
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: HealthUtah PPO |
$15.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.91
|
| Rate for Payer: Multiplan Medicare/VA |
$8.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.06
|
| Rate for Payer: PacificSource Commercial |
$13.83
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: PHCS PPO |
$15.06
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: Three Rivers PPO |
$11.53
|
| Rate for Payer: TriWest Veterans Administration |
$8.91
|
| Rate for Payer: TriWest Veterans Administration |
$8.85
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Commercial |
$13.37
|
| Rate for Payer: United Healthcare Medicare |
$8.91
|
| Rate for Payer: United Healthcare Medicare |
$8.85
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: WINHealth Partners Commercial |
$15.06
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.60
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [46072]
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$9.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.73
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.29
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$8.73
|
| Rate for Payer: United Healthcare Commercial |
$13.09
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION [46072]
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.45
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.93
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$9.44
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$9.93
|
| Rate for Payer: United Healthcare Commercial |
$13.09
|
| Rate for Payer: United Healthcare Medicare |
$9.93
|
| Rate for Payer: WINHealth Partners Commercial |
$14.30
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4277]
|
Facility
|
IP
|
$19.54
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.76
|
| Rate for Payer: Altius Commercial |
$18.76
|
| Rate for Payer: Beech Street Commercial |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.95
|
| Rate for Payer: Cigna of WY Commercial |
$19.15
|
| Rate for Payer: Entrust Commercial |
$18.56
|
| Rate for Payer: First Choice Health Commercial |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.90
|
| Rate for Payer: HealthUtah PPO |
$19.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.95
|
| Rate for Payer: Multiplan Medicare/VA |
$12.25
|
| Rate for Payer: One Health Plan of WY PPO |
$19.15
|
| Rate for Payer: PacificSource Commercial |
$17.59
|
| Rate for Payer: PHCS PPO |
$19.15
|
| Rate for Payer: Three Rivers PPO |
$14.66
|
| Rate for Payer: TriWest Veterans Administration |
$12.90
|
| Rate for Payer: United Healthcare Commercial |
$17.00
|
| Rate for Payer: United Healthcare Medicare |
$12.90
|
| Rate for Payer: WINHealth Partners Commercial |
$18.56
|
| Rate for Payer: Wise Provider Network Commercial |
$18.56
|
|
|
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION [4277]
|
Facility
|
OP
|
$19.54
|
|
|
Service Code
|
HCPCS J3475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$19.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.15
|
| Rate for Payer: Aetna of WY Medicare |
$12.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.76
|
| Rate for Payer: Altius Commercial |
$18.76
|
| Rate for Payer: Beech Street Commercial |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.95
|
| Rate for Payer: Cigna of WY Commercial |
$19.15
|
| Rate for Payer: Entrust Commercial |
$18.56
|
| Rate for Payer: First Choice Health Commercial |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.33
|
| Rate for Payer: HealthUtah PPO |
$19.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.95
|
| Rate for Payer: Multiplan Medicare/VA |
$10.77
|
| Rate for Payer: One Health Plan of WY PPO |
$19.15
|
| Rate for Payer: PacificSource Commercial |
$17.59
|
| Rate for Payer: PHCS PPO |
$19.15
|
| Rate for Payer: Three Rivers PPO |
$14.66
|
| Rate for Payer: TriWest Veterans Administration |
$11.33
|
| Rate for Payer: United Healthcare Commercial |
$17.00
|
| Rate for Payer: United Healthcare Medicare |
$11.33
|
| Rate for Payer: WINHealth Partners Commercial |
$19.15
|
| Rate for Payer: Wise Provider Network Commercial |
$18.56
|
|
|
MAGNESIUM SULFATE IVPB BOLUS - TORSADES DE POINTES [4090000108]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 0338170940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
MAGNESIUM SULFATE IVPB BOLUS - TORSADES DE POINTES [4090000108]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 0338170940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.25
|
| Rate for Payer: Altius Commercial |
$0.25
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.25
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.25
|
| Rate for Payer: First Choice Health Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.25
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.20
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.25
|
|
|
MAJOR ORTHO PACK TOTAL KNEE
|
Facility
|
OP
|
$910.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.64 |
| Max. Negotiated Rate |
$910.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.21
|
| Rate for Payer: Aetna of WY Medicare |
$600.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$874.00
|
| Rate for Payer: Altius Commercial |
$874.00
|
| Rate for Payer: Beech Street Commercial |
$892.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$747.45
|
| Rate for Payer: Cash Price |
$637.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.11
|
| Rate for Payer: Cigna of WY Commercial |
$892.21
|
| Rate for Payer: Entrust Commercial |
$864.90
|
| Rate for Payer: First Choice Health Commercial |
$864.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.04
|
| Rate for Payer: HealthUtah PPO |
$910.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.11
|
| Rate for Payer: Multiplan Medicare/VA |
$501.64
|
| Rate for Payer: One Health Plan of WY PPO |
$892.21
|
| Rate for Payer: PacificSource Commercial |
$819.38
|
| Rate for Payer: PHCS PPO |
$892.21
|
| Rate for Payer: Three Rivers PPO |
$682.82
|
| Rate for Payer: TriWest Veterans Administration |
$528.04
|
| Rate for Payer: United Healthcare Commercial |
$792.07
|
| Rate for Payer: United Healthcare Medicare |
$528.04
|
| Rate for Payer: WINHealth Partners Commercial |
$892.21
|
| Rate for Payer: Wise Provider Network Commercial |
$864.90
|
|
|
MAJOR ORTHO PACK TOTAL KNEE
|
Facility
|
IP
|
$910.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$910.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$874.00
|
| Rate for Payer: Altius Commercial |
$874.00
|
| Rate for Payer: Beech Street Commercial |
$892.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$747.45
|
| Rate for Payer: Cash Price |
$637.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.11
|
| Rate for Payer: Cigna of WY Commercial |
$892.21
|
| Rate for Payer: Entrust Commercial |
$864.90
|
| Rate for Payer: First Choice Health Commercial |
$864.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$600.88
|
| Rate for Payer: HealthUtah PPO |
$910.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.11
|
| Rate for Payer: Multiplan Medicare/VA |
$570.83
|
| Rate for Payer: One Health Plan of WY PPO |
$892.21
|
| Rate for Payer: PacificSource Commercial |
$819.38
|
| Rate for Payer: PHCS PPO |
$892.21
|
| Rate for Payer: Three Rivers PPO |
$682.82
|
| Rate for Payer: TriWest Veterans Administration |
$600.88
|
| Rate for Payer: United Healthcare Commercial |
$792.07
|
| Rate for Payer: United Healthcare Medicare |
$600.88
|
| Rate for Payer: WINHealth Partners Commercial |
$864.90
|
| Rate for Payer: Wise Provider Network Commercial |
$864.90
|
|
|
MAKENA, 10 MG
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
J1726
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 26341
|
| Hospital Charge Code |
26341
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$76.48
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.48
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$65.01
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.48
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$76.48
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
|
|
MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$2,198.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
24300
|
| Min. Negotiated Rate |
$372.79 |
| Max. Negotiated Rate |
$2,198.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,154.04
|
| Rate for Payer: Aetna of WY Medicare |
$438.58
|
| Rate for Payer: Beech Street Commercial |
$2,088.10
|
| Rate for Payer: Cash Price |
$1,538.60
|
| Rate for Payer: Cash Price |
$1,538.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,132.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,154.04
|
| Rate for Payer: First Choice Health Commercial |
$1,978.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,088.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.58
|
| Rate for Payer: HealthUtah PPO |
$2,198.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,132.06
|
| Rate for Payer: Multiplan Medicare/VA |
$372.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,154.04
|
| Rate for Payer: PacificSource Commercial |
$1,978.20
|
| Rate for Payer: PHCS PPO |
$2,088.10
|
| Rate for Payer: Three Rivers PPO |
$1,648.50
|
| Rate for Payer: TriWest Veterans Administration |
$438.58
|
| Rate for Payer: United Healthcare Commercial |
$1,912.26
|
| Rate for Payer: United Healthcare Medicare |
$438.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,868.30
|
|
|
MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
26340
|
| Min. Negotiated Rate |
$303.77 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,725.78
|
| Rate for Payer: Aetna of WY Medicare |
$357.38
|
| Rate for Payer: Beech Street Commercial |
$1,672.95
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,708.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,725.78
|
| Rate for Payer: First Choice Health Commercial |
$1,584.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,672.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$357.38
|
| Rate for Payer: HealthUtah PPO |
$1,761.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,708.17
|
| Rate for Payer: Multiplan Medicare/VA |
$303.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,725.78
|
| Rate for Payer: PacificSource Commercial |
$1,584.90
|
| Rate for Payer: PHCS PPO |
$1,672.95
|
| Rate for Payer: Three Rivers PPO |
$1,320.75
|
| Rate for Payer: TriWest Veterans Administration |
$357.38
|
| Rate for Payer: United Healthcare Commercial |
$1,532.07
|
| Rate for Payer: United Healthcare Medicare |
$357.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.85
|
|
|
MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,528.80
|
| Rate for Payer: Aetna of WY Medicare |
$150.74
|
| Rate for Payer: Beech Street Commercial |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,513.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,528.80
|
| Rate for Payer: First Choice Health Commercial |
$1,404.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.74
|
| Rate for Payer: HealthUtah PPO |
$1,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,513.20
|
| Rate for Payer: Multiplan Medicare/VA |
$128.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,528.80
|
| Rate for Payer: PacificSource Commercial |
$1,404.00
|
| Rate for Payer: PHCS PPO |
$1,482.00
|
| Rate for Payer: Three Rivers PPO |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.74
|
| Rate for Payer: United Healthcare Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare Medicare |
$150.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.00
|
|
|
MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 27570 80
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,528.80
|
| Rate for Payer: Aetna of WY Medicare |
$150.74
|
| Rate for Payer: Beech Street Commercial |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,513.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,528.80
|
| Rate for Payer: First Choice Health Commercial |
$1,404.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.74
|
| Rate for Payer: HealthUtah PPO |
$1,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,513.20
|
| Rate for Payer: Multiplan Medicare/VA |
$128.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,528.80
|
| Rate for Payer: PacificSource Commercial |
$1,404.00
|
| Rate for Payer: PHCS PPO |
$1,482.00
|
| Rate for Payer: Three Rivers PPO |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.74
|
| Rate for Payer: United Healthcare Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare Medicare |
$150.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.00
|
|
|
MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$3,119.00
|
|
|
Service Code
|
HCPCS 27570 50
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$3,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,056.62
|
| Rate for Payer: Aetna of WY Medicare |
$150.74
|
| Rate for Payer: Beech Street Commercial |
$2,963.05
|
| Rate for Payer: Cash Price |
$2,183.30
|
| Rate for Payer: Cash Price |
$2,183.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,025.43
|
| Rate for Payer: Cigna of WY Commercial |
$3,056.62
|
| Rate for Payer: First Choice Health Commercial |
$2,807.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,963.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.74
|
| Rate for Payer: HealthUtah PPO |
$3,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,025.43
|
| Rate for Payer: Multiplan Medicare/VA |
$128.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3,056.62
|
| Rate for Payer: PacificSource Commercial |
$2,807.10
|
| Rate for Payer: PHCS PPO |
$2,963.05
|
| Rate for Payer: Three Rivers PPO |
$2,339.25
|
| Rate for Payer: TriWest Veterans Administration |
$150.74
|
| Rate for Payer: United Healthcare Commercial |
$2,713.53
|
| Rate for Payer: United Healthcare Medicare |
$150.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2,651.15
|
|
|
MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$4,508.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
25259
|
| Min. Negotiated Rate |
$366.47 |
| Max. Negotiated Rate |
$4,508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,417.84
|
| Rate for Payer: Aetna of WY Medicare |
$431.14
|
| Rate for Payer: Beech Street Commercial |
$4,282.60
|
| Rate for Payer: Cash Price |
$3,155.60
|
| Rate for Payer: Cash Price |
$3,155.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,372.76
|
| Rate for Payer: Cigna of WY Commercial |
$4,417.84
|
| Rate for Payer: First Choice Health Commercial |
$4,057.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.14
|
| Rate for Payer: HealthUtah PPO |
$4,508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,372.76
|
| Rate for Payer: Multiplan Medicare/VA |
$366.47
|
| Rate for Payer: One Health Plan of WY PPO |
$4,417.84
|
| Rate for Payer: PacificSource Commercial |
$4,057.20
|
| Rate for Payer: PHCS PPO |
$4,282.60
|
| Rate for Payer: Three Rivers PPO |
$3,381.00
|
| Rate for Payer: TriWest Veterans Administration |
$431.14
|
| Rate for Payer: United Healthcare Commercial |
$3,921.96
|
| Rate for Payer: United Healthcare Medicare |
$431.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3,831.80
|
|
|
MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
77071
|
| Min. Negotiated Rate |
$45.42 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$310.66
|
| Rate for Payer: Aetna of WY Medicare |
$53.43
|
| Rate for Payer: Beech Street Commercial |
$301.15
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$307.49
|
| Rate for Payer: Cigna of WY Commercial |
$310.66
|
| Rate for Payer: First Choice Health Commercial |
$285.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.43
|
| Rate for Payer: HealthUtah PPO |
$317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$307.49
|
| Rate for Payer: Multiplan Medicare/VA |
$45.42
|
| Rate for Payer: One Health Plan of WY PPO |
$310.66
|
| Rate for Payer: PacificSource Commercial |
$285.30
|
| Rate for Payer: PHCS PPO |
$301.15
|
| Rate for Payer: Three Rivers PPO |
$237.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.43
|
| Rate for Payer: United Healthcare Commercial |
$275.79
|
| Rate for Payer: United Healthcare Medicare |
$53.43
|
| Rate for Payer: WINHealth Partners Commercial |
$301.15
|
|
|
MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
97140
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.28
|
| Rate for Payer: Aetna of WY Medicare |
$26.44
|
| Rate for Payer: Beech Street Commercial |
$176.70
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.42
|
| Rate for Payer: Cigna of WY Commercial |
$182.28
|
| Rate for Payer: First Choice Health Commercial |
$167.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.44
|
| Rate for Payer: HealthUtah PPO |
$186.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.42
|
| Rate for Payer: Multiplan Medicare/VA |
$22.47
|
| Rate for Payer: One Health Plan of WY PPO |
$182.28
|
| Rate for Payer: PacificSource Commercial |
$167.40
|
| Rate for Payer: PHCS PPO |
$176.70
|
| Rate for Payer: Three Rivers PPO |
$139.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.44
|
| Rate for Payer: United Healthcare Commercial |
$161.82
|
| Rate for Payer: United Healthcare Medicare |
$26.44
|
| Rate for Payer: WINHealth Partners Commercial |
$176.70
|
|
|
MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
56440
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$614.46
|
| Rate for Payer: Aetna of WY Medicare |
$175.66
|
| Rate for Payer: Beech Street Commercial |
$595.65
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$608.19
|
| Rate for Payer: Cigna of WY Commercial |
$614.46
|
| Rate for Payer: First Choice Health Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$595.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.66
|
| Rate for Payer: HealthUtah PPO |
$627.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$608.19
|
| Rate for Payer: Multiplan Medicare/VA |
$149.31
|
| Rate for Payer: One Health Plan of WY PPO |
$614.46
|
| Rate for Payer: PacificSource Commercial |
$564.30
|
| Rate for Payer: PHCS PPO |
$595.65
|
| Rate for Payer: Three Rivers PPO |
$470.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.66
|
| Rate for Payer: United Healthcare Commercial |
$545.49
|
| Rate for Payer: United Healthcare Medicare |
$175.66
|
| Rate for Payer: WINHealth Partners Commercial |
$532.95
|
|
|
MASK BVM ADULT PEEP & MANOMETER
|
Facility
|
OP
|
$32.44
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$32.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.79
|
| Rate for Payer: Aetna of WY Medicare |
$21.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.14
|
| Rate for Payer: Altius Commercial |
$31.14
|
| Rate for Payer: Beech Street Commercial |
$31.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.63
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.47
|
| Rate for Payer: Cigna of WY Commercial |
$31.79
|
| Rate for Payer: Entrust Commercial |
$30.82
|
| Rate for Payer: First Choice Health Commercial |
$30.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.82
|
| Rate for Payer: HealthUtah PPO |
$32.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.47
|
| Rate for Payer: Multiplan Medicare/VA |
$17.87
|
| Rate for Payer: One Health Plan of WY PPO |
$31.79
|
| Rate for Payer: PacificSource Commercial |
$29.20
|
| Rate for Payer: PHCS PPO |
$31.79
|
| Rate for Payer: Three Rivers PPO |
$24.33
|
| Rate for Payer: TriWest Veterans Administration |
$18.82
|
| Rate for Payer: United Healthcare Commercial |
$28.22
|
| Rate for Payer: United Healthcare Medicare |
$18.82
|
| Rate for Payer: WINHealth Partners Commercial |
$31.79
|
| Rate for Payer: Wise Provider Network Commercial |
$30.82
|
|
|
MASK BVM ADULT PEEP & MANOMETER
|
Facility
|
IP
|
$32.44
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$32.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.14
|
| Rate for Payer: Altius Commercial |
$31.14
|
| Rate for Payer: Beech Street Commercial |
$31.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.63
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.47
|
| Rate for Payer: Cigna of WY Commercial |
$31.79
|
| Rate for Payer: Entrust Commercial |
$30.82
|
| Rate for Payer: First Choice Health Commercial |
$30.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.41
|
| Rate for Payer: HealthUtah PPO |
$32.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.47
|
| Rate for Payer: Multiplan Medicare/VA |
$20.34
|
| Rate for Payer: One Health Plan of WY PPO |
$31.79
|
| Rate for Payer: PacificSource Commercial |
$29.20
|
| Rate for Payer: PHCS PPO |
$31.79
|
| Rate for Payer: Three Rivers PPO |
$24.33
|
| Rate for Payer: TriWest Veterans Administration |
$21.41
|
| Rate for Payer: United Healthcare Commercial |
$28.22
|
| Rate for Payer: United Healthcare Medicare |
$21.41
|
| Rate for Payer: WINHealth Partners Commercial |
$30.82
|
| Rate for Payer: Wise Provider Network Commercial |
$30.82
|
|
|
MASK BVM INFANT PEEP & MANOMETER
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$38.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.85
|
| Rate for Payer: Aetna of WY Medicare |
$25.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.08
|
| Rate for Payer: Altius Commercial |
$37.08
|
| Rate for Payer: Beech Street Commercial |
$37.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.71
|
| Rate for Payer: Cash Price |
$27.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.46
|
| Rate for Payer: Cigna of WY Commercial |
$37.85
|
| Rate for Payer: Entrust Commercial |
$36.69
|
| Rate for Payer: First Choice Health Commercial |
$36.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.40
|
| Rate for Payer: HealthUtah PPO |
$38.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.46
|
| Rate for Payer: Multiplan Medicare/VA |
$21.28
|
| Rate for Payer: One Health Plan of WY PPO |
$37.85
|
| Rate for Payer: PacificSource Commercial |
$34.76
|
| Rate for Payer: PHCS PPO |
$37.85
|
| Rate for Payer: Three Rivers PPO |
$28.96
|
| Rate for Payer: TriWest Veterans Administration |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$33.60
|
| Rate for Payer: United Healthcare Medicare |
$22.40
|
| Rate for Payer: WINHealth Partners Commercial |
$37.85
|
| Rate for Payer: Wise Provider Network Commercial |
$36.69
|
|
