|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
OP
|
$17.41
|
|
|
Service Code
|
NDC 4202318901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.06
|
| Rate for Payer: Aetna of WY Medicare |
$11.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.71
|
| Rate for Payer: Altius Commercial |
$16.71
|
| Rate for Payer: Beech Street Commercial |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.89
|
| Rate for Payer: Cigna of WY Commercial |
$17.06
|
| Rate for Payer: Entrust Commercial |
$16.54
|
| Rate for Payer: First Choice Health Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$17.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$17.06
|
| Rate for Payer: PacificSource Commercial |
$15.67
|
| Rate for Payer: PHCS PPO |
$17.06
|
| Rate for Payer: Three Rivers PPO |
$13.06
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$17.06
|
| Rate for Payer: Wise Provider Network Commercial |
$16.54
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
IP
|
$17.41
|
|
|
Service Code
|
NDC 4202318901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.71
|
| Rate for Payer: Altius Commercial |
$16.71
|
| Rate for Payer: Beech Street Commercial |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.89
|
| Rate for Payer: Cigna of WY Commercial |
$17.06
|
| Rate for Payer: Entrust Commercial |
$16.54
|
| Rate for Payer: First Choice Health Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.49
|
| Rate for Payer: HealthUtah PPO |
$17.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.89
|
| Rate for Payer: Multiplan Medicare/VA |
$10.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.06
|
| Rate for Payer: PacificSource Commercial |
$15.67
|
| Rate for Payer: PHCS PPO |
$17.06
|
| Rate for Payer: Three Rivers PPO |
$13.06
|
| Rate for Payer: TriWest Veterans Administration |
$11.49
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare |
$11.49
|
| Rate for Payer: WINHealth Partners Commercial |
$16.54
|
| Rate for Payer: Wise Provider Network Commercial |
$16.54
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
OP
|
$17.41
|
|
|
Service Code
|
NDC 4202318910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.06
|
| Rate for Payer: Aetna of WY Medicare |
$11.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.71
|
| Rate for Payer: Altius Commercial |
$16.71
|
| Rate for Payer: Beech Street Commercial |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.89
|
| Rate for Payer: Cigna of WY Commercial |
$17.06
|
| Rate for Payer: Entrust Commercial |
$16.54
|
| Rate for Payer: First Choice Health Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$17.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$17.06
|
| Rate for Payer: PacificSource Commercial |
$15.67
|
| Rate for Payer: PHCS PPO |
$17.06
|
| Rate for Payer: Three Rivers PPO |
$13.06
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$17.06
|
| Rate for Payer: Wise Provider Network Commercial |
$16.54
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 2315551841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
IP
|
$17.41
|
|
|
Service Code
|
NDC 4202318910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.71
|
| Rate for Payer: Altius Commercial |
$16.71
|
| Rate for Payer: Beech Street Commercial |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.89
|
| Rate for Payer: Cigna of WY Commercial |
$17.06
|
| Rate for Payer: Entrust Commercial |
$16.54
|
| Rate for Payer: First Choice Health Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.49
|
| Rate for Payer: HealthUtah PPO |
$17.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.89
|
| Rate for Payer: Multiplan Medicare/VA |
$10.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.06
|
| Rate for Payer: PacificSource Commercial |
$15.67
|
| Rate for Payer: PHCS PPO |
$17.06
|
| Rate for Payer: Three Rivers PPO |
$13.06
|
| Rate for Payer: TriWest Veterans Administration |
$11.49
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare |
$11.49
|
| Rate for Payer: WINHealth Partners Commercial |
$16.54
|
| Rate for Payer: Wise Provider Network Commercial |
$16.54
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 7006980601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 2315551841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Aetna of WY Medicare |
$11.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.44
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.44
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$10.44
|
| Rate for Payer: WINHealth Partners Commercial |
$17.64
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [128770]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 7006980601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Aetna of WY Medicare |
$11.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.44
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.44
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$10.44
|
| Rate for Payer: WINHealth Partners Commercial |
$17.64
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
NEPHRECTOMY PARTIAL
|
Professional
|
Both
|
$6,861.00
|
|
|
Service Code
|
HCPCS 50240 80
|
| Hospital Charge Code |
50240
|
| Min. Negotiated Rate |
$1,077.70 |
| Max. Negotiated Rate |
$6,861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,723.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,267.88
|
| Rate for Payer: Beech Street Commercial |
$6,517.95
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,655.17
|
| Rate for Payer: Cigna of WY Commercial |
$6,723.78
|
| Rate for Payer: First Choice Health Commercial |
$6,174.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,517.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,267.88
|
| Rate for Payer: HealthUtah PPO |
$6,861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,655.17
|
| Rate for Payer: Multiplan Medicare/VA |
$1,077.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,723.78
|
| Rate for Payer: PacificSource Commercial |
$6,174.90
|
| Rate for Payer: PHCS PPO |
$6,517.95
|
| Rate for Payer: Three Rivers PPO |
$5,145.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,267.88
|
| Rate for Payer: United Healthcare Commercial |
$5,969.07
|
| Rate for Payer: United Healthcare Medicare |
$1,267.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.85
|
|
|
NEPHRECTOMY PARTIAL
|
Professional
|
Both
|
$6,861.00
|
|
|
Service Code
|
HCPCS 50240 AS
|
| Hospital Charge Code |
50240
|
| Min. Negotiated Rate |
$1,077.70 |
| Max. Negotiated Rate |
$6,861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,723.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,267.88
|
| Rate for Payer: Beech Street Commercial |
$6,517.95
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,655.17
|
| Rate for Payer: Cigna of WY Commercial |
$6,723.78
|
| Rate for Payer: First Choice Health Commercial |
$6,174.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,517.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,267.88
|
| Rate for Payer: HealthUtah PPO |
$6,861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,655.17
|
| Rate for Payer: Multiplan Medicare/VA |
$1,077.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,723.78
|
| Rate for Payer: PacificSource Commercial |
$6,174.90
|
| Rate for Payer: PHCS PPO |
$6,517.95
|
| Rate for Payer: Three Rivers PPO |
$5,145.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,267.88
|
| Rate for Payer: United Healthcare Commercial |
$5,969.07
|
| Rate for Payer: United Healthcare Medicare |
$1,267.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.85
|
|
|
NEPHRECTOMY PARTIAL
|
Professional
|
Both
|
$6,861.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
50240
|
| Min. Negotiated Rate |
$1,077.70 |
| Max. Negotiated Rate |
$6,861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,723.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,267.88
|
| Rate for Payer: Beech Street Commercial |
$6,517.95
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: Cash Price |
$4,802.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,655.17
|
| Rate for Payer: Cigna of WY Commercial |
$6,723.78
|
| Rate for Payer: First Choice Health Commercial |
$6,174.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,517.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,267.88
|
| Rate for Payer: HealthUtah PPO |
$6,861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,655.17
|
| Rate for Payer: Multiplan Medicare/VA |
$1,077.70
|
| Rate for Payer: One Health Plan of WY PPO |
$6,723.78
|
| Rate for Payer: PacificSource Commercial |
$6,174.90
|
| Rate for Payer: PHCS PPO |
$6,517.95
|
| Rate for Payer: Three Rivers PPO |
$5,145.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,267.88
|
| Rate for Payer: United Healthcare Commercial |
$5,969.07
|
| Rate for Payer: United Healthcare Medicare |
$1,267.88
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.85
|
|
|
NERVE CONDUCTION STUDIES 11-12 STUDIES
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
95912
|
| Min. Negotiated Rate |
$204.94 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$834.96
|
| Rate for Payer: Aetna of WY Medicare |
$241.11
|
| Rate for Payer: Beech Street Commercial |
$809.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$826.44
|
| Rate for Payer: Cigna of WY Commercial |
$834.96
|
| Rate for Payer: First Choice Health Commercial |
$766.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$809.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$241.11
|
| Rate for Payer: HealthUtah PPO |
$852.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$826.44
|
| Rate for Payer: Multiplan Medicare/VA |
$204.94
|
| Rate for Payer: One Health Plan of WY PPO |
$834.96
|
| Rate for Payer: PacificSource Commercial |
$766.80
|
| Rate for Payer: PHCS PPO |
$809.40
|
| Rate for Payer: Three Rivers PPO |
$639.00
|
| Rate for Payer: TriWest Veterans Administration |
$241.11
|
| Rate for Payer: United Healthcare Commercial |
$741.24
|
| Rate for Payer: United Healthcare Medicare |
$241.11
|
| Rate for Payer: WINHealth Partners Commercial |
$809.40
|
|
|
NERVE CONDUCTION STUDIES 1-2 STUDIES
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
95907
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.76
|
| Rate for Payer: Aetna of WY Medicare |
$87.98
|
| Rate for Payer: Beech Street Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.64
|
| Rate for Payer: Cigna of WY Commercial |
$305.76
|
| Rate for Payer: First Choice Health Commercial |
$280.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.98
|
| Rate for Payer: HealthUtah PPO |
$312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.64
|
| Rate for Payer: Multiplan Medicare/VA |
$74.78
|
| Rate for Payer: One Health Plan of WY PPO |
$305.76
|
| Rate for Payer: PacificSource Commercial |
$280.80
|
| Rate for Payer: PHCS PPO |
$296.40
|
| Rate for Payer: Three Rivers PPO |
$234.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.98
|
| Rate for Payer: United Healthcare Commercial |
$271.44
|
| Rate for Payer: United Healthcare Medicare |
$87.98
|
| Rate for Payer: WINHealth Partners Commercial |
$296.40
|
|
|
NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
95913
|
| Min. Negotiated Rate |
$236.53 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$969.22
|
| Rate for Payer: Aetna of WY Medicare |
$278.27
|
| Rate for Payer: Beech Street Commercial |
$939.55
|
| Rate for Payer: Cash Price |
$692.30
|
| Rate for Payer: Cash Price |
$692.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$959.33
|
| Rate for Payer: Cigna of WY Commercial |
$969.22
|
| Rate for Payer: First Choice Health Commercial |
$890.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$939.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.27
|
| Rate for Payer: HealthUtah PPO |
$989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$959.33
|
| Rate for Payer: Multiplan Medicare/VA |
$236.53
|
| Rate for Payer: One Health Plan of WY PPO |
$969.22
|
| Rate for Payer: PacificSource Commercial |
$890.10
|
| Rate for Payer: PHCS PPO |
$939.55
|
| Rate for Payer: Three Rivers PPO |
$741.75
|
| Rate for Payer: TriWest Veterans Administration |
$278.27
|
| Rate for Payer: United Healthcare Commercial |
$860.43
|
| Rate for Payer: United Healthcare Medicare |
$278.27
|
| Rate for Payer: WINHealth Partners Commercial |
$939.55
|
|
|
NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
95908
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$109.18
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.18
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$92.80
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.18
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$109.18
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
|
|
NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
95909
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$473.34
|
| Rate for Payer: Aetna of WY Medicare |
$131.03
|
| Rate for Payer: Beech Street Commercial |
$458.85
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$468.51
|
| Rate for Payer: Cigna of WY Commercial |
$473.34
|
| Rate for Payer: First Choice Health Commercial |
$434.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$458.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.03
|
| Rate for Payer: HealthUtah PPO |
$483.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$468.51
|
| Rate for Payer: Multiplan Medicare/VA |
$111.38
|
| Rate for Payer: One Health Plan of WY PPO |
$473.34
|
| Rate for Payer: PacificSource Commercial |
$434.70
|
| Rate for Payer: PHCS PPO |
$458.85
|
| Rate for Payer: Three Rivers PPO |
$362.25
|
| Rate for Payer: TriWest Veterans Administration |
$131.03
|
| Rate for Payer: United Healthcare Commercial |
$420.21
|
| Rate for Payer: United Healthcare Medicare |
$131.03
|
| Rate for Payer: WINHealth Partners Commercial |
$458.85
|
|
|
NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
95910
|
| Min. Negotiated Rate |
$484.50 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$633.08
|
| Rate for Payer: Beech Street Commercial |
$613.70
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$626.62
|
| Rate for Payer: Cigna of WY Commercial |
$633.08
|
| Rate for Payer: First Choice Health Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$613.70
|
| Rate for Payer: HealthUtah PPO |
$646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$626.62
|
| Rate for Payer: One Health Plan of WY PPO |
$633.08
|
| Rate for Payer: PacificSource Commercial |
$581.40
|
| Rate for Payer: PHCS PPO |
$613.70
|
| Rate for Payer: Three Rivers PPO |
$484.50
|
| Rate for Payer: United Healthcare Commercial |
$562.02
|
| Rate for Payer: WINHealth Partners Commercial |
$613.70
|
|
|
NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
95911
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$206.33
|
| Rate for Payer: Beech Street Commercial |
$731.50
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: First Choice Health Commercial |
$693.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.33
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$175.38
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$731.50
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$206.33
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$206.33
|
| Rate for Payer: WINHealth Partners Commercial |
$731.50
|
|
|
NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$4,073.00
|
|
|
Service Code
|
HCPCS 64910
|
| Hospital Charge Code |
64910
|
| Min. Negotiated Rate |
$626.37 |
| Max. Negotiated Rate |
$4,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,991.54
|
| Rate for Payer: Aetna of WY Medicare |
$736.91
|
| Rate for Payer: Beech Street Commercial |
$3,869.35
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,950.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,991.54
|
| Rate for Payer: First Choice Health Commercial |
$3,665.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,869.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.91
|
| Rate for Payer: HealthUtah PPO |
$4,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,950.81
|
| Rate for Payer: Multiplan Medicare/VA |
$626.37
|
| Rate for Payer: One Health Plan of WY PPO |
$3,991.54
|
| Rate for Payer: PacificSource Commercial |
$3,665.70
|
| Rate for Payer: PHCS PPO |
$3,869.35
|
| Rate for Payer: Three Rivers PPO |
$3,054.75
|
| Rate for Payer: TriWest Veterans Administration |
$736.91
|
| Rate for Payer: United Healthcare Commercial |
$3,543.51
|
| Rate for Payer: United Healthcare Medicare |
$736.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.05
|
|
|
NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$4,073.00
|
|
|
Service Code
|
HCPCS 64910 AS
|
| Hospital Charge Code |
64910
|
| Min. Negotiated Rate |
$626.37 |
| Max. Negotiated Rate |
$4,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,991.54
|
| Rate for Payer: Aetna of WY Medicare |
$736.91
|
| Rate for Payer: Beech Street Commercial |
$3,869.35
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: Cash Price |
$2,851.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,950.81
|
| Rate for Payer: Cigna of WY Commercial |
$3,991.54
|
| Rate for Payer: First Choice Health Commercial |
$3,665.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,869.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.91
|
| Rate for Payer: HealthUtah PPO |
$4,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,950.81
|
| Rate for Payer: Multiplan Medicare/VA |
$626.37
|
| Rate for Payer: One Health Plan of WY PPO |
$3,991.54
|
| Rate for Payer: PacificSource Commercial |
$3,665.70
|
| Rate for Payer: PHCS PPO |
$3,869.35
|
| Rate for Payer: Three Rivers PPO |
$3,054.75
|
| Rate for Payer: TriWest Veterans Administration |
$736.91
|
| Rate for Payer: United Healthcare Commercial |
$3,543.51
|
| Rate for Payer: United Healthcare Medicare |
$736.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.05
|
|
|
NEURO PACK
|
Facility
|
OP
|
$373.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.83 |
| Max. Negotiated Rate |
$373.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.09
|
| Rate for Payer: Aetna of WY Medicare |
$246.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$358.62
|
| Rate for Payer: Altius Commercial |
$358.62
|
| Rate for Payer: Beech Street Commercial |
$366.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$306.69
|
| Rate for Payer: Cash Price |
$261.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$362.35
|
| Rate for Payer: Cigna of WY Commercial |
$366.09
|
| Rate for Payer: Entrust Commercial |
$354.88
|
| Rate for Payer: First Choice Health Commercial |
$354.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$354.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.66
|
| Rate for Payer: HealthUtah PPO |
$373.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$362.35
|
| Rate for Payer: Multiplan Medicare/VA |
$205.83
|
| Rate for Payer: One Health Plan of WY PPO |
$366.09
|
| Rate for Payer: PacificSource Commercial |
$336.20
|
| Rate for Payer: PHCS PPO |
$366.09
|
| Rate for Payer: Three Rivers PPO |
$280.17
|
| Rate for Payer: TriWest Veterans Administration |
$216.66
|
| Rate for Payer: United Healthcare Commercial |
$325.00
|
| Rate for Payer: United Healthcare Medicare |
$216.66
|
| Rate for Payer: WINHealth Partners Commercial |
$366.09
|
| Rate for Payer: Wise Provider Network Commercial |
$354.88
|
|
|
NEURO PACK
|
Facility
|
IP
|
$373.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$373.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$358.62
|
| Rate for Payer: Altius Commercial |
$358.62
|
| Rate for Payer: Beech Street Commercial |
$366.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$306.69
|
| Rate for Payer: Cash Price |
$261.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$362.35
|
| Rate for Payer: Cigna of WY Commercial |
$366.09
|
| Rate for Payer: Entrust Commercial |
$354.88
|
| Rate for Payer: First Choice Health Commercial |
$354.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$354.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.55
|
| Rate for Payer: HealthUtah PPO |
$373.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$362.35
|
| Rate for Payer: Multiplan Medicare/VA |
$234.22
|
| Rate for Payer: One Health Plan of WY PPO |
$366.09
|
| Rate for Payer: PacificSource Commercial |
$336.20
|
| Rate for Payer: PHCS PPO |
$366.09
|
| Rate for Payer: Three Rivers PPO |
$280.17
|
| Rate for Payer: TriWest Veterans Administration |
$246.55
|
| Rate for Payer: United Healthcare Commercial |
$325.00
|
| Rate for Payer: United Healthcare Medicare |
$246.55
|
| Rate for Payer: WINHealth Partners Commercial |
$354.88
|
| Rate for Payer: Wise Provider Network Commercial |
$354.88
|
|
|
NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,599.00
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
64702
|
| Min. Negotiated Rate |
$427.86 |
| Max. Negotiated Rate |
$2,599.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,547.02
|
| Rate for Payer: Aetna of WY Medicare |
$503.36
|
| Rate for Payer: Beech Street Commercial |
$2,469.05
|
| Rate for Payer: Cash Price |
$1,819.30
|
| Rate for Payer: Cash Price |
$1,819.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,521.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,547.02
|
| Rate for Payer: First Choice Health Commercial |
$2,339.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,469.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$503.36
|
| Rate for Payer: HealthUtah PPO |
$2,599.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,521.03
|
| Rate for Payer: Multiplan Medicare/VA |
$427.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,547.02
|
| Rate for Payer: PacificSource Commercial |
$2,339.10
|
| Rate for Payer: PHCS PPO |
$2,469.05
|
| Rate for Payer: Three Rivers PPO |
$1,949.25
|
| Rate for Payer: TriWest Veterans Administration |
$503.36
|
| Rate for Payer: United Healthcare Commercial |
$2,261.13
|
| Rate for Payer: United Healthcare Medicare |
$503.36
|
| Rate for Payer: WINHealth Partners Commercial |
$2,209.15
|
|
|
NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 64704
|
| Hospital Charge Code |
64704
|
| Min. Negotiated Rate |
$269.88 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,631.70
|
| Rate for Payer: Aetna of WY Medicare |
$317.50
|
| Rate for Payer: Beech Street Commercial |
$1,581.75
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,615.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,631.70
|
| Rate for Payer: First Choice Health Commercial |
$1,498.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,581.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.50
|
| Rate for Payer: HealthUtah PPO |
$1,665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,615.05
|
| Rate for Payer: Multiplan Medicare/VA |
$269.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,631.70
|
| Rate for Payer: PacificSource Commercial |
$1,498.50
|
| Rate for Payer: PHCS PPO |
$1,581.75
|
| Rate for Payer: Three Rivers PPO |
$1,248.75
|
| Rate for Payer: TriWest Veterans Administration |
$317.50
|
| Rate for Payer: United Healthcare Commercial |
$1,448.55
|
| Rate for Payer: United Healthcare Medicare |
$317.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,415.25
|
|
|
NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$3,068.00
|
|
|
Service Code
|
HCPCS 64718 80
|
| Hospital Charge Code |
64718
|
| Min. Negotiated Rate |
$501.64 |
| Max. Negotiated Rate |
$3,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,006.64
|
| Rate for Payer: Aetna of WY Medicare |
$590.17
|
| Rate for Payer: Beech Street Commercial |
$2,914.60
|
| Rate for Payer: Cash Price |
$2,147.60
|
| Rate for Payer: Cash Price |
$2,147.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,975.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,006.64
|
| Rate for Payer: First Choice Health Commercial |
$2,761.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,914.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$590.17
|
| Rate for Payer: HealthUtah PPO |
$3,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,975.96
|
| Rate for Payer: Multiplan Medicare/VA |
$501.64
|
| Rate for Payer: One Health Plan of WY PPO |
$3,006.64
|
| Rate for Payer: PacificSource Commercial |
$2,761.20
|
| Rate for Payer: PHCS PPO |
$2,914.60
|
| Rate for Payer: Three Rivers PPO |
$2,301.00
|
| Rate for Payer: TriWest Veterans Administration |
$590.17
|
| Rate for Payer: United Healthcare Commercial |
$2,669.16
|
| Rate for Payer: United Healthcare Medicare |
$590.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,607.80
|
|
