|
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 93923 26
|
| Hospital Charge Code |
93923
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$648.76
|
| Rate for Payer: Aetna of WY Medicare |
$20.44
|
| Rate for Payer: Beech Street Commercial |
$628.90
|
| Rate for Payer: Cash Price |
$463.40
|
| Rate for Payer: Cash Price |
$463.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$642.14
|
| Rate for Payer: Cigna of WY Commercial |
$648.76
|
| Rate for Payer: First Choice Health Commercial |
$595.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$628.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.44
|
| Rate for Payer: HealthUtah PPO |
$662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$642.14
|
| Rate for Payer: Multiplan Medicare/VA |
$17.37
|
| Rate for Payer: One Health Plan of WY PPO |
$648.76
|
| Rate for Payer: PacificSource Commercial |
$595.80
|
| Rate for Payer: PHCS PPO |
$628.90
|
| Rate for Payer: Three Rivers PPO |
$496.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.44
|
| Rate for Payer: United Healthcare Commercial |
$575.94
|
| Rate for Payer: United Healthcare Medicare |
$20.44
|
| Rate for Payer: WINHealth Partners Commercial |
$628.90
|
|
|
NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
93922
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.86
|
| Rate for Payer: Aetna of WY Medicare |
$80.45
|
| Rate for Payer: Beech Street Commercial |
$434.15
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$443.29
|
| Rate for Payer: Cigna of WY Commercial |
$447.86
|
| Rate for Payer: First Choice Health Commercial |
$411.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$434.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.45
|
| Rate for Payer: HealthUtah PPO |
$457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$443.29
|
| Rate for Payer: Multiplan Medicare/VA |
$68.38
|
| Rate for Payer: One Health Plan of WY PPO |
$447.86
|
| Rate for Payer: PacificSource Commercial |
$411.30
|
| Rate for Payer: PHCS PPO |
$434.15
|
| Rate for Payer: Three Rivers PPO |
$342.75
|
| Rate for Payer: TriWest Veterans Administration |
$80.45
|
| Rate for Payer: United Healthcare Commercial |
$397.59
|
| Rate for Payer: United Healthcare Medicare |
$80.45
|
| Rate for Payer: WINHealth Partners Commercial |
$434.15
|
|
|
NON-PNEUM WALK BOOT PRE CST
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS L4386
|
| Hospital Charge Code |
L4386
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$188.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$188.59
|
| Rate for Payer: Beech Street Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: First Choice Health Commercial |
$118.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.59
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$160.30
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$125.40
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$188.59
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$188.59
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
|
|
NON-PNEUM WALK BOOT PRE OTS
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS L4387
|
| Hospital Charge Code |
L4387
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
NDC 0409337514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.98
|
| Rate for Payer: Aetna of WY Medicare |
$22.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.28
|
| Rate for Payer: Altius Commercial |
$33.28
|
| Rate for Payer: Beech Street Commercial |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.46
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.63
|
| Rate for Payer: Cigna of WY Commercial |
$33.98
|
| Rate for Payer: Entrust Commercial |
$32.94
|
| Rate for Payer: First Choice Health Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.11
|
| Rate for Payer: HealthUtah PPO |
$34.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.63
|
| Rate for Payer: Multiplan Medicare/VA |
$19.10
|
| Rate for Payer: One Health Plan of WY PPO |
$33.98
|
| Rate for Payer: PacificSource Commercial |
$31.20
|
| Rate for Payer: PHCS PPO |
$33.98
|
| Rate for Payer: Three Rivers PPO |
$26.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.11
|
| Rate for Payer: United Healthcare Commercial |
$30.16
|
| Rate for Payer: United Healthcare Medicare |
$20.11
|
| Rate for Payer: WINHealth Partners Commercial |
$33.98
|
| Rate for Payer: Wise Provider Network Commercial |
$32.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 4306699701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.20
|
| Rate for Payer: Altius Commercial |
$19.20
|
| Rate for Payer: Beech Street Commercial |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: Entrust Commercial |
$19.00
|
| Rate for Payer: First Choice Health Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.20
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$12.54
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.60
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.20
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
| Rate for Payer: Wise Provider Network Commercial |
$19.00
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$26.95
|
|
|
Service Code
|
NDC 0781375595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.41
|
| Rate for Payer: Aetna of WY Medicare |
$17.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.87
|
| Rate for Payer: Altius Commercial |
$25.87
|
| Rate for Payer: Beech Street Commercial |
$26.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.13
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.14
|
| Rate for Payer: Cigna of WY Commercial |
$26.41
|
| Rate for Payer: Entrust Commercial |
$25.60
|
| Rate for Payer: First Choice Health Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.63
|
| Rate for Payer: HealthUtah PPO |
$26.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.14
|
| Rate for Payer: Multiplan Medicare/VA |
$14.85
|
| Rate for Payer: One Health Plan of WY PPO |
$26.41
|
| Rate for Payer: PacificSource Commercial |
$24.26
|
| Rate for Payer: PHCS PPO |
$26.41
|
| Rate for Payer: Three Rivers PPO |
$20.21
|
| Rate for Payer: TriWest Veterans Administration |
$15.63
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare |
$15.63
|
| Rate for Payer: WINHealth Partners Commercial |
$26.41
|
| Rate for Payer: Wise Provider Network Commercial |
$25.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$34.67
|
|
|
Service Code
|
NDC 0409337504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.28
|
| Rate for Payer: Altius Commercial |
$33.28
|
| Rate for Payer: Beech Street Commercial |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.46
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.63
|
| Rate for Payer: Cigna of WY Commercial |
$33.98
|
| Rate for Payer: Entrust Commercial |
$32.94
|
| Rate for Payer: First Choice Health Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.88
|
| Rate for Payer: HealthUtah PPO |
$34.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.63
|
| Rate for Payer: Multiplan Medicare/VA |
$21.74
|
| Rate for Payer: One Health Plan of WY PPO |
$33.98
|
| Rate for Payer: PacificSource Commercial |
$31.20
|
| Rate for Payer: PHCS PPO |
$33.98
|
| Rate for Payer: Three Rivers PPO |
$26.00
|
| Rate for Payer: TriWest Veterans Administration |
$22.88
|
| Rate for Payer: United Healthcare Commercial |
$30.16
|
| Rate for Payer: United Healthcare Medicare |
$22.88
|
| Rate for Payer: WINHealth Partners Commercial |
$32.94
|
| Rate for Payer: Wise Provider Network Commercial |
$32.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$31.89
|
|
|
Service Code
|
NDC 7012115761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.25
|
| Rate for Payer: Aetna of WY Medicare |
$21.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.61
|
| Rate for Payer: Altius Commercial |
$30.61
|
| Rate for Payer: Beech Street Commercial |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.18
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.93
|
| Rate for Payer: Cigna of WY Commercial |
$31.25
|
| Rate for Payer: Entrust Commercial |
$30.30
|
| Rate for Payer: First Choice Health Commercial |
$30.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.50
|
| Rate for Payer: HealthUtah PPO |
$31.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.93
|
| Rate for Payer: Multiplan Medicare/VA |
$17.57
|
| Rate for Payer: One Health Plan of WY PPO |
$31.25
|
| Rate for Payer: PacificSource Commercial |
$28.70
|
| Rate for Payer: PHCS PPO |
$31.25
|
| Rate for Payer: Three Rivers PPO |
$23.92
|
| Rate for Payer: TriWest Veterans Administration |
$18.50
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WINHealth Partners Commercial |
$31.25
|
| Rate for Payer: Wise Provider Network Commercial |
$30.30
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$31.89
|
|
|
Service Code
|
NDC 7012115761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.61
|
| Rate for Payer: Altius Commercial |
$30.61
|
| Rate for Payer: Beech Street Commercial |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.18
|
| Rate for Payer: Cash Price |
$22.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.93
|
| Rate for Payer: Cigna of WY Commercial |
$31.25
|
| Rate for Payer: Entrust Commercial |
$30.30
|
| Rate for Payer: First Choice Health Commercial |
$30.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.05
|
| Rate for Payer: HealthUtah PPO |
$31.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.93
|
| Rate for Payer: Multiplan Medicare/VA |
$20.00
|
| Rate for Payer: One Health Plan of WY PPO |
$31.25
|
| Rate for Payer: PacificSource Commercial |
$28.70
|
| Rate for Payer: PHCS PPO |
$31.25
|
| Rate for Payer: Three Rivers PPO |
$23.92
|
| Rate for Payer: TriWest Veterans Administration |
$21.05
|
| Rate for Payer: United Healthcare Commercial |
$27.74
|
| Rate for Payer: United Healthcare Medicare |
$21.05
|
| Rate for Payer: WINHealth Partners Commercial |
$30.30
|
| Rate for Payer: Wise Provider Network Commercial |
$30.30
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$26.95
|
|
|
Service Code
|
NDC 0781375595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.87
|
| Rate for Payer: Altius Commercial |
$25.87
|
| Rate for Payer: Beech Street Commercial |
$26.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.13
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.14
|
| Rate for Payer: Cigna of WY Commercial |
$26.41
|
| Rate for Payer: Entrust Commercial |
$25.60
|
| Rate for Payer: First Choice Health Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.79
|
| Rate for Payer: HealthUtah PPO |
$26.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.14
|
| Rate for Payer: Multiplan Medicare/VA |
$16.90
|
| Rate for Payer: One Health Plan of WY PPO |
$26.41
|
| Rate for Payer: PacificSource Commercial |
$24.26
|
| Rate for Payer: PHCS PPO |
$26.41
|
| Rate for Payer: Three Rivers PPO |
$20.21
|
| Rate for Payer: TriWest Veterans Administration |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare |
$17.79
|
| Rate for Payer: WINHealth Partners Commercial |
$25.60
|
| Rate for Payer: Wise Provider Network Commercial |
$25.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 4306699701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Aetna of WY Medicare |
$13.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.20
|
| Rate for Payer: Altius Commercial |
$19.20
|
| Rate for Payer: Beech Street Commercial |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: Entrust Commercial |
$19.00
|
| Rate for Payer: First Choice Health Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.60
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WINHealth Partners Commercial |
$19.60
|
| Rate for Payer: Wise Provider Network Commercial |
$19.00
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
NDC 0409337504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.98
|
| Rate for Payer: Aetna of WY Medicare |
$22.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.28
|
| Rate for Payer: Altius Commercial |
$33.28
|
| Rate for Payer: Beech Street Commercial |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.46
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.63
|
| Rate for Payer: Cigna of WY Commercial |
$33.98
|
| Rate for Payer: Entrust Commercial |
$32.94
|
| Rate for Payer: First Choice Health Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.11
|
| Rate for Payer: HealthUtah PPO |
$34.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.63
|
| Rate for Payer: Multiplan Medicare/VA |
$19.10
|
| Rate for Payer: One Health Plan of WY PPO |
$33.98
|
| Rate for Payer: PacificSource Commercial |
$31.20
|
| Rate for Payer: PHCS PPO |
$33.98
|
| Rate for Payer: Three Rivers PPO |
$26.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.11
|
| Rate for Payer: United Healthcare Commercial |
$30.16
|
| Rate for Payer: United Healthcare Medicare |
$20.11
|
| Rate for Payer: WINHealth Partners Commercial |
$33.98
|
| Rate for Payer: Wise Provider Network Commercial |
$32.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
OP
|
$26.95
|
|
|
Service Code
|
NDC 0781375575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.41
|
| Rate for Payer: Aetna of WY Medicare |
$17.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.87
|
| Rate for Payer: Altius Commercial |
$25.87
|
| Rate for Payer: Beech Street Commercial |
$26.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.13
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.14
|
| Rate for Payer: Cigna of WY Commercial |
$26.41
|
| Rate for Payer: Entrust Commercial |
$25.60
|
| Rate for Payer: First Choice Health Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.63
|
| Rate for Payer: HealthUtah PPO |
$26.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.14
|
| Rate for Payer: Multiplan Medicare/VA |
$14.85
|
| Rate for Payer: One Health Plan of WY PPO |
$26.41
|
| Rate for Payer: PacificSource Commercial |
$24.26
|
| Rate for Payer: PHCS PPO |
$26.41
|
| Rate for Payer: Three Rivers PPO |
$20.21
|
| Rate for Payer: TriWest Veterans Administration |
$15.63
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare |
$15.63
|
| Rate for Payer: WINHealth Partners Commercial |
$26.41
|
| Rate for Payer: Wise Provider Network Commercial |
$25.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$26.95
|
|
|
Service Code
|
NDC 0781375575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.87
|
| Rate for Payer: Altius Commercial |
$25.87
|
| Rate for Payer: Beech Street Commercial |
$26.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.13
|
| Rate for Payer: Cash Price |
$18.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.14
|
| Rate for Payer: Cigna of WY Commercial |
$26.41
|
| Rate for Payer: Entrust Commercial |
$25.60
|
| Rate for Payer: First Choice Health Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.79
|
| Rate for Payer: HealthUtah PPO |
$26.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.14
|
| Rate for Payer: Multiplan Medicare/VA |
$16.90
|
| Rate for Payer: One Health Plan of WY PPO |
$26.41
|
| Rate for Payer: PacificSource Commercial |
$24.26
|
| Rate for Payer: PHCS PPO |
$26.41
|
| Rate for Payer: Three Rivers PPO |
$20.21
|
| Rate for Payer: TriWest Veterans Administration |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$23.45
|
| Rate for Payer: United Healthcare Medicare |
$17.79
|
| Rate for Payer: WINHealth Partners Commercial |
$25.60
|
| Rate for Payer: Wise Provider Network Commercial |
$25.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [19610]
|
Facility
|
IP
|
$34.67
|
|
|
Service Code
|
NDC 0409337514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.28
|
| Rate for Payer: Altius Commercial |
$33.28
|
| Rate for Payer: Beech Street Commercial |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.46
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.63
|
| Rate for Payer: Cigna of WY Commercial |
$33.98
|
| Rate for Payer: Entrust Commercial |
$32.94
|
| Rate for Payer: First Choice Health Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.88
|
| Rate for Payer: HealthUtah PPO |
$34.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.63
|
| Rate for Payer: Multiplan Medicare/VA |
$21.74
|
| Rate for Payer: One Health Plan of WY PPO |
$33.98
|
| Rate for Payer: PacificSource Commercial |
$31.20
|
| Rate for Payer: PHCS PPO |
$33.98
|
| Rate for Payer: Three Rivers PPO |
$26.00
|
| Rate for Payer: TriWest Veterans Administration |
$22.88
|
| Rate for Payer: United Healthcare Commercial |
$30.16
|
| Rate for Payer: United Healthcare Medicare |
$22.88
|
| Rate for Payer: WINHealth Partners Commercial |
$32.94
|
| Rate for Payer: Wise Provider Network Commercial |
$32.94
|
|
|
NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [87048]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 4456764010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Aetna of WY Medicare |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [87048]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 4456764001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Aetna of WY Medicare |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [87048]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 4456764001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [87048]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 4456764010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
NOVASURE ABLATION KIT NS2013KITUS
|
Facility
|
OP
|
$4,813.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,652.11 |
| Max. Negotiated Rate |
$4,813.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,717.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,176.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,620.74
|
| Rate for Payer: Altius Commercial |
$4,620.74
|
| Rate for Payer: Beech Street Commercial |
$4,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,951.69
|
| Rate for Payer: Cash Price |
$3,369.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.87
|
| Rate for Payer: Cigna of WY Commercial |
$4,717.00
|
| Rate for Payer: Entrust Commercial |
$4,572.61
|
| Rate for Payer: First Choice Health Commercial |
$4,572.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,572.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,791.70
|
| Rate for Payer: HealthUtah PPO |
$4,813.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.87
|
| Rate for Payer: Multiplan Medicare/VA |
$2,652.11
|
| Rate for Payer: One Health Plan of WY PPO |
$4,717.00
|
| Rate for Payer: PacificSource Commercial |
$4,331.94
|
| Rate for Payer: PHCS PPO |
$4,717.00
|
| Rate for Payer: Three Rivers PPO |
$3,609.95
|
| Rate for Payer: TriWest Veterans Administration |
$2,791.70
|
| Rate for Payer: United Healthcare Commercial |
$4,187.54
|
| Rate for Payer: United Healthcare Medicare |
$2,791.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,717.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,572.61
|
|
|
NOVASURE ABLATION KIT NS2013KITUS
|
Facility
|
IP
|
$4,813.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,017.92 |
| Max. Negotiated Rate |
$4,813.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,717.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,620.74
|
| Rate for Payer: Altius Commercial |
$4,620.74
|
| Rate for Payer: Beech Street Commercial |
$4,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,951.69
|
| Rate for Payer: Cash Price |
$3,369.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,668.87
|
| Rate for Payer: Cigna of WY Commercial |
$4,717.00
|
| Rate for Payer: Entrust Commercial |
$4,572.61
|
| Rate for Payer: First Choice Health Commercial |
$4,572.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,572.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,176.76
|
| Rate for Payer: HealthUtah PPO |
$4,813.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,668.87
|
| Rate for Payer: Multiplan Medicare/VA |
$3,017.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4,717.00
|
| Rate for Payer: PacificSource Commercial |
$4,331.94
|
| Rate for Payer: PHCS PPO |
$4,717.00
|
| Rate for Payer: Three Rivers PPO |
$3,609.95
|
| Rate for Payer: TriWest Veterans Administration |
$3,176.76
|
| Rate for Payer: United Healthcare Commercial |
$4,187.54
|
| Rate for Payer: United Healthcare Medicare |
$3,176.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4,572.61
|
| Rate for Payer: Wise Provider Network Commercial |
$4,572.61
|
|
|
NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
HCPCS 31267 50
|
| Hospital Charge Code |
31267
|
| Min. Negotiated Rate |
$215.42 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,772.82
|
| Rate for Payer: Aetna of WY Medicare |
$253.44
|
| Rate for Payer: Beech Street Commercial |
$1,718.55
|
| Rate for Payer: Cash Price |
$1,266.30
|
| Rate for Payer: Cash Price |
$1,266.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,754.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,772.82
|
| Rate for Payer: First Choice Health Commercial |
$1,628.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,718.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.44
|
| Rate for Payer: HealthUtah PPO |
$1,809.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,754.73
|
| Rate for Payer: Multiplan Medicare/VA |
$215.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,772.82
|
| Rate for Payer: PacificSource Commercial |
$1,628.10
|
| Rate for Payer: PHCS PPO |
$1,718.55
|
| Rate for Payer: Three Rivers PPO |
$1,356.75
|
| Rate for Payer: TriWest Veterans Administration |
$253.44
|
| Rate for Payer: United Healthcare Commercial |
$1,573.83
|
| Rate for Payer: United Healthcare Medicare |
$253.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,537.65
|
|
|
NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
31267
|
| Min. Negotiated Rate |
$215.42 |
| Max. Negotiated Rate |
$904.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$885.92
|
| Rate for Payer: Aetna of WY Medicare |
$253.44
|
| Rate for Payer: Beech Street Commercial |
$858.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: Cash Price |
$632.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$876.88
|
| Rate for Payer: Cigna of WY Commercial |
$885.92
|
| Rate for Payer: First Choice Health Commercial |
$813.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$858.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.44
|
| Rate for Payer: HealthUtah PPO |
$904.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$876.88
|
| Rate for Payer: Multiplan Medicare/VA |
$215.42
|
| Rate for Payer: One Health Plan of WY PPO |
$885.92
|
| Rate for Payer: PacificSource Commercial |
$813.60
|
| Rate for Payer: PHCS PPO |
$858.80
|
| Rate for Payer: Three Rivers PPO |
$678.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.44
|
| Rate for Payer: United Healthcare Commercial |
$786.48
|
| Rate for Payer: United Healthcare Medicare |
$253.44
|
| Rate for Payer: WINHealth Partners Commercial |
$768.40
|
|
|
NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
|
Professional
|
Both
|
$1,594.00
|
|
|
Service Code
|
HCPCS 31288 50
|
| Hospital Charge Code |
31288
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$1,594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,562.12
|
| Rate for Payer: Aetna of WY Medicare |
$223.43
|
| Rate for Payer: Beech Street Commercial |
$1,514.30
|
| Rate for Payer: Cash Price |
$1,115.80
|
| Rate for Payer: Cash Price |
$1,115.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,546.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,562.12
|
| Rate for Payer: First Choice Health Commercial |
$1,434.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,514.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.43
|
| Rate for Payer: HealthUtah PPO |
$1,594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,546.18
|
| Rate for Payer: Multiplan Medicare/VA |
$189.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,562.12
|
| Rate for Payer: PacificSource Commercial |
$1,434.60
|
| Rate for Payer: PHCS PPO |
$1,514.30
|
| Rate for Payer: Three Rivers PPO |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration |
$223.43
|
| Rate for Payer: United Healthcare Commercial |
$1,386.78
|
| Rate for Payer: United Healthcare Medicare |
$223.43
|
| Rate for Payer: WINHealth Partners Commercial |
$1,354.90
|
|
