|
9 MM ENTRY DRILL
|
Facility
|
OP
|
$1,510.60
|
|
| Hospital Charge Code |
3002137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.99 |
| Max. Negotiated Rate |
$1,510.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,480.39
|
| Rate for Payer: Aetna of WY Medicare |
$997.00
|
| Rate for Payer: Altius Commercial |
$1,450.18
|
| Rate for Payer: Beech Street Commercial |
$1,480.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,465.28
|
| Rate for Payer: Cash Price |
$1,057.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,465.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,480.39
|
| Rate for Payer: Entrust Commercial |
$1,435.07
|
| Rate for Payer: First Choice Health Commercial |
$1,435.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,435.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$861.04
|
| Rate for Payer: HealthUtah PPO |
$1,510.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,465.28
|
| Rate for Payer: Multiplan Medicare/VA |
$817.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,480.39
|
| Rate for Payer: PacificSource Commercial |
$1,359.54
|
| Rate for Payer: PHCS PPO |
$1,480.39
|
| Rate for Payer: Three Rivers PPO |
$1,132.95
|
| Rate for Payer: TriWest Veterans Administration |
$861.04
|
| Rate for Payer: United Healthcare Commercial |
$1,442.62
|
| Rate for Payer: United Healthcare Medicare |
$861.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,480.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1,435.07
|
|
|
9 MM ENTRY DRILL
|
Facility
|
IP
|
$1,510.60
|
|
| Hospital Charge Code |
3002137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$875.39 |
| Max. Negotiated Rate |
$1,510.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,480.39
|
| Rate for Payer: Aetna of WY Medicare |
$966.78
|
| Rate for Payer: Altius Commercial |
$1,450.18
|
| Rate for Payer: Beech Street Commercial |
$1,480.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,465.28
|
| Rate for Payer: Cash Price |
$1,057.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,465.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,480.39
|
| Rate for Payer: Entrust Commercial |
$1,435.07
|
| Rate for Payer: First Choice Health Commercial |
$1,435.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,435.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$921.47
|
| Rate for Payer: HealthUtah PPO |
$1,510.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,465.28
|
| Rate for Payer: Multiplan Medicare/VA |
$875.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,480.39
|
| Rate for Payer: PacificSource Commercial |
$1,359.54
|
| Rate for Payer: PHCS PPO |
$1,480.39
|
| Rate for Payer: Three Rivers PPO |
$1,132.95
|
| Rate for Payer: TriWest Veterans Administration |
$921.47
|
| Rate for Payer: United Healthcare Commercial |
$1,442.62
|
| Rate for Payer: United Healthcare Medicare |
$921.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,435.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,435.07
|
|
|
9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$312.75 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$408.66
|
| Rate for Payer: Beech Street Commercial |
$396.15
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$404.49
|
| Rate for Payer: Cigna of WY Commercial |
$408.66
|
| Rate for Payer: First Choice Health Commercial |
$375.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$396.15
|
| Rate for Payer: HealthUtah PPO |
$417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$404.49
|
| Rate for Payer: One Health Plan of WY PPO |
$408.66
|
| Rate for Payer: PacificSource Commercial |
$375.30
|
| Rate for Payer: PHCS PPO |
$396.15
|
| Rate for Payer: Three Rivers PPO |
$312.75
|
| Rate for Payer: United Healthcare Commercial |
$396.15
|
| Rate for Payer: WINHealth Partners Commercial |
$417.00
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [40098]
|
Facility
|
IP
|
$1,443.20
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$836.33 |
| Max. Negotiated Rate |
$1,443.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,414.34
|
| Rate for Payer: Aetna of WY Medicare |
$923.65
|
| Rate for Payer: Altius Commercial |
$1,385.47
|
| Rate for Payer: Beech Street Commercial |
$1,414.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,399.90
|
| Rate for Payer: Cash Price |
$1,010.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,399.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,414.34
|
| Rate for Payer: Entrust Commercial |
$1,371.04
|
| Rate for Payer: First Choice Health Commercial |
$1,371.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,371.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$880.35
|
| Rate for Payer: HealthUtah PPO |
$1,443.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,399.90
|
| Rate for Payer: Multiplan Medicare/VA |
$836.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,414.34
|
| Rate for Payer: PacificSource Commercial |
$1,298.88
|
| Rate for Payer: PHCS PPO |
$1,414.34
|
| Rate for Payer: Three Rivers PPO |
$1,082.40
|
| Rate for Payer: TriWest Veterans Administration |
$880.35
|
| Rate for Payer: United Healthcare Commercial |
$1,378.26
|
| Rate for Payer: United Healthcare Medicare |
$880.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,371.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1,371.04
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [40098]
|
Facility
|
OP
|
$1,443.20
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$781.49 |
| Max. Negotiated Rate |
$1,443.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,414.34
|
| Rate for Payer: Aetna of WY Medicare |
$952.51
|
| Rate for Payer: Altius Commercial |
$1,385.47
|
| Rate for Payer: Beech Street Commercial |
$1,414.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,399.90
|
| Rate for Payer: Cash Price |
$1,010.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,399.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,414.34
|
| Rate for Payer: Entrust Commercial |
$1,371.04
|
| Rate for Payer: First Choice Health Commercial |
$1,371.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,371.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$822.62
|
| Rate for Payer: HealthUtah PPO |
$1,443.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,399.90
|
| Rate for Payer: Multiplan Medicare/VA |
$781.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,414.34
|
| Rate for Payer: PacificSource Commercial |
$1,298.88
|
| Rate for Payer: PHCS PPO |
$1,414.34
|
| Rate for Payer: Three Rivers PPO |
$1,082.40
|
| Rate for Payer: TriWest Veterans Administration |
$822.62
|
| Rate for Payer: United Healthcare Commercial |
$1,378.26
|
| Rate for Payer: United Healthcare Medicare |
$822.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,414.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1,371.04
|
|
|
ABDOMIANL BINDER XL 79-89328
|
Facility
|
IP
|
$40.50
|
|
| Hospital Charge Code |
2200233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.69
|
| Rate for Payer: Aetna of WY Medicare |
$25.92
|
| Rate for Payer: Altius Commercial |
$38.88
|
| Rate for Payer: Beech Street Commercial |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.28
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.28
|
| Rate for Payer: Cigna of WY Commercial |
$39.69
|
| Rate for Payer: Entrust Commercial |
$38.48
|
| Rate for Payer: First Choice Health Commercial |
$38.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.70
|
| Rate for Payer: HealthUtah PPO |
$40.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.28
|
| Rate for Payer: Multiplan Medicare/VA |
$23.47
|
| Rate for Payer: One Health Plan of WY PPO |
$39.69
|
| Rate for Payer: PacificSource Commercial |
$36.45
|
| Rate for Payer: PHCS PPO |
$39.69
|
| Rate for Payer: Three Rivers PPO |
$30.38
|
| Rate for Payer: TriWest Veterans Administration |
$24.70
|
| Rate for Payer: United Healthcare Commercial |
$38.68
|
| Rate for Payer: United Healthcare Medicare |
$24.70
|
| Rate for Payer: WINHealth Partners Commercial |
$38.48
|
| Rate for Payer: Wise Provider Network Commercial |
$38.48
|
|
|
ABDOMIANL BINDER XL 79-89328
|
Facility
|
OP
|
$40.50
|
|
| Hospital Charge Code |
2200233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.69
|
| Rate for Payer: Aetna of WY Medicare |
$26.73
|
| Rate for Payer: Altius Commercial |
$38.88
|
| Rate for Payer: Beech Street Commercial |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.28
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.28
|
| Rate for Payer: Cigna of WY Commercial |
$39.69
|
| Rate for Payer: Entrust Commercial |
$38.48
|
| Rate for Payer: First Choice Health Commercial |
$38.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.08
|
| Rate for Payer: HealthUtah PPO |
$40.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.28
|
| Rate for Payer: Multiplan Medicare/VA |
$21.93
|
| Rate for Payer: One Health Plan of WY PPO |
$39.69
|
| Rate for Payer: PacificSource Commercial |
$36.45
|
| Rate for Payer: PHCS PPO |
$39.69
|
| Rate for Payer: Three Rivers PPO |
$30.38
|
| Rate for Payer: TriWest Veterans Administration |
$23.08
|
| Rate for Payer: United Healthcare Commercial |
$38.68
|
| Rate for Payer: United Healthcare Medicare |
$23.08
|
| Rate for Payer: WINHealth Partners Commercial |
$39.69
|
| Rate for Payer: Wise Provider Network Commercial |
$38.48
|
|
|
ABDOMINAL BINDER 2XL 79-89189
|
Facility
|
OP
|
$31.64
|
|
| Hospital Charge Code |
2200227
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.01
|
| Rate for Payer: Aetna of WY Medicare |
$20.88
|
| Rate for Payer: Altius Commercial |
$30.37
|
| Rate for Payer: Beech Street Commercial |
$31.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.69
|
| Rate for Payer: Cash Price |
$22.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.69
|
| Rate for Payer: Cigna of WY Commercial |
$31.01
|
| Rate for Payer: Entrust Commercial |
$30.06
|
| Rate for Payer: First Choice Health Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.03
|
| Rate for Payer: HealthUtah PPO |
$31.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.69
|
| Rate for Payer: Multiplan Medicare/VA |
$17.13
|
| Rate for Payer: One Health Plan of WY PPO |
$31.01
|
| Rate for Payer: PacificSource Commercial |
$28.48
|
| Rate for Payer: PHCS PPO |
$31.01
|
| Rate for Payer: Three Rivers PPO |
$23.73
|
| Rate for Payer: TriWest Veterans Administration |
$18.03
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
| Rate for Payer: United Healthcare Medicare |
$18.03
|
| Rate for Payer: WINHealth Partners Commercial |
$31.01
|
| Rate for Payer: Wise Provider Network Commercial |
$30.06
|
|
|
ABDOMINAL BINDER 2XL 79-89189
|
Facility
|
IP
|
$31.64
|
|
| Hospital Charge Code |
2200227
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.01
|
| Rate for Payer: Aetna of WY Medicare |
$20.25
|
| Rate for Payer: Altius Commercial |
$30.37
|
| Rate for Payer: Beech Street Commercial |
$31.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.69
|
| Rate for Payer: Cash Price |
$22.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.69
|
| Rate for Payer: Cigna of WY Commercial |
$31.01
|
| Rate for Payer: Entrust Commercial |
$30.06
|
| Rate for Payer: First Choice Health Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.30
|
| Rate for Payer: HealthUtah PPO |
$31.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.69
|
| Rate for Payer: Multiplan Medicare/VA |
$18.34
|
| Rate for Payer: One Health Plan of WY PPO |
$31.01
|
| Rate for Payer: PacificSource Commercial |
$28.48
|
| Rate for Payer: PHCS PPO |
$31.01
|
| Rate for Payer: Three Rivers PPO |
$23.73
|
| Rate for Payer: TriWest Veterans Administration |
$19.30
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
| Rate for Payer: United Healthcare Medicare |
$19.30
|
| Rate for Payer: WINHealth Partners Commercial |
$30.06
|
| Rate for Payer: Wise Provider Network Commercial |
$30.06
|
|
|
ABDOMINAL BINDER 3XL 79-89260
|
Facility
|
IP
|
$32.02
|
|
| Hospital Charge Code |
2200234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.38
|
| Rate for Payer: Aetna of WY Medicare |
$20.49
|
| Rate for Payer: Altius Commercial |
$30.74
|
| Rate for Payer: Beech Street Commercial |
$31.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.06
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.06
|
| Rate for Payer: Cigna of WY Commercial |
$31.38
|
| Rate for Payer: Entrust Commercial |
$30.42
|
| Rate for Payer: First Choice Health Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.53
|
| Rate for Payer: HealthUtah PPO |
$32.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.06
|
| Rate for Payer: Multiplan Medicare/VA |
$18.56
|
| Rate for Payer: One Health Plan of WY PPO |
$31.38
|
| Rate for Payer: PacificSource Commercial |
$28.82
|
| Rate for Payer: PHCS PPO |
$31.38
|
| Rate for Payer: Three Rivers PPO |
$24.02
|
| Rate for Payer: TriWest Veterans Administration |
$19.53
|
| Rate for Payer: United Healthcare Commercial |
$30.58
|
| Rate for Payer: United Healthcare Medicare |
$19.53
|
| Rate for Payer: WINHealth Partners Commercial |
$30.42
|
| Rate for Payer: Wise Provider Network Commercial |
$30.42
|
|
|
ABDOMINAL BINDER 3XL 79-89260
|
Facility
|
OP
|
$32.02
|
|
| Hospital Charge Code |
2200234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.38
|
| Rate for Payer: Aetna of WY Medicare |
$21.13
|
| Rate for Payer: Altius Commercial |
$30.74
|
| Rate for Payer: Beech Street Commercial |
$31.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.06
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.06
|
| Rate for Payer: Cigna of WY Commercial |
$31.38
|
| Rate for Payer: Entrust Commercial |
$30.42
|
| Rate for Payer: First Choice Health Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.25
|
| Rate for Payer: HealthUtah PPO |
$32.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.06
|
| Rate for Payer: Multiplan Medicare/VA |
$17.34
|
| Rate for Payer: One Health Plan of WY PPO |
$31.38
|
| Rate for Payer: PacificSource Commercial |
$28.82
|
| Rate for Payer: PHCS PPO |
$31.38
|
| Rate for Payer: Three Rivers PPO |
$24.02
|
| Rate for Payer: TriWest Veterans Administration |
$18.25
|
| Rate for Payer: United Healthcare Commercial |
$30.58
|
| Rate for Payer: United Healthcare Medicare |
$18.25
|
| Rate for Payer: WINHealth Partners Commercial |
$31.38
|
| Rate for Payer: Wise Provider Network Commercial |
$30.42
|
|
|
ABDOMINAL BINDER L&D LG/XL
|
Facility
|
IP
|
$66.46
|
|
| Hospital Charge Code |
2450114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.13
|
| Rate for Payer: Aetna of WY Medicare |
$42.53
|
| Rate for Payer: Altius Commercial |
$63.80
|
| Rate for Payer: Beech Street Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.47
|
| Rate for Payer: Cigna of WY Commercial |
$65.13
|
| Rate for Payer: Entrust Commercial |
$63.14
|
| Rate for Payer: First Choice Health Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.54
|
| Rate for Payer: HealthUtah PPO |
$66.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.47
|
| Rate for Payer: Multiplan Medicare/VA |
$38.51
|
| Rate for Payer: One Health Plan of WY PPO |
$65.13
|
| Rate for Payer: PacificSource Commercial |
$59.81
|
| Rate for Payer: PHCS PPO |
$65.13
|
| Rate for Payer: Three Rivers PPO |
$49.84
|
| Rate for Payer: TriWest Veterans Administration |
$40.54
|
| Rate for Payer: United Healthcare Commercial |
$63.47
|
| Rate for Payer: United Healthcare Medicare |
$40.54
|
| Rate for Payer: WINHealth Partners Commercial |
$63.14
|
| Rate for Payer: Wise Provider Network Commercial |
$63.14
|
|
|
ABDOMINAL BINDER L&D LG/XL
|
Facility
|
OP
|
$66.46
|
|
| Hospital Charge Code |
2450114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.13
|
| Rate for Payer: Aetna of WY Medicare |
$43.86
|
| Rate for Payer: Altius Commercial |
$63.80
|
| Rate for Payer: Beech Street Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.47
|
| Rate for Payer: Cigna of WY Commercial |
$65.13
|
| Rate for Payer: Entrust Commercial |
$63.14
|
| Rate for Payer: First Choice Health Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.88
|
| Rate for Payer: HealthUtah PPO |
$66.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.47
|
| Rate for Payer: Multiplan Medicare/VA |
$35.99
|
| Rate for Payer: One Health Plan of WY PPO |
$65.13
|
| Rate for Payer: PacificSource Commercial |
$59.81
|
| Rate for Payer: PHCS PPO |
$65.13
|
| Rate for Payer: Three Rivers PPO |
$49.84
|
| Rate for Payer: TriWest Veterans Administration |
$37.88
|
| Rate for Payer: United Healthcare Commercial |
$63.47
|
| Rate for Payer: United Healthcare Medicare |
$37.88
|
| Rate for Payer: WINHealth Partners Commercial |
$65.13
|
| Rate for Payer: Wise Provider Network Commercial |
$63.14
|
|
|
ABDOMINAL BINDER L&D SM/MD
|
Facility
|
IP
|
$66.46
|
|
| Hospital Charge Code |
2450113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.13
|
| Rate for Payer: Aetna of WY Medicare |
$42.53
|
| Rate for Payer: Altius Commercial |
$63.80
|
| Rate for Payer: Beech Street Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.47
|
| Rate for Payer: Cigna of WY Commercial |
$65.13
|
| Rate for Payer: Entrust Commercial |
$63.14
|
| Rate for Payer: First Choice Health Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.54
|
| Rate for Payer: HealthUtah PPO |
$66.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.47
|
| Rate for Payer: Multiplan Medicare/VA |
$38.51
|
| Rate for Payer: One Health Plan of WY PPO |
$65.13
|
| Rate for Payer: PacificSource Commercial |
$59.81
|
| Rate for Payer: PHCS PPO |
$65.13
|
| Rate for Payer: Three Rivers PPO |
$49.84
|
| Rate for Payer: TriWest Veterans Administration |
$40.54
|
| Rate for Payer: United Healthcare Commercial |
$63.47
|
| Rate for Payer: United Healthcare Medicare |
$40.54
|
| Rate for Payer: WINHealth Partners Commercial |
$63.14
|
| Rate for Payer: Wise Provider Network Commercial |
$63.14
|
|
|
ABDOMINAL BINDER L&D SM/MD
|
Facility
|
OP
|
$66.46
|
|
| Hospital Charge Code |
2450113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.13
|
| Rate for Payer: Aetna of WY Medicare |
$43.86
|
| Rate for Payer: Altius Commercial |
$63.80
|
| Rate for Payer: Beech Street Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.47
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.47
|
| Rate for Payer: Cigna of WY Commercial |
$65.13
|
| Rate for Payer: Entrust Commercial |
$63.14
|
| Rate for Payer: First Choice Health Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.88
|
| Rate for Payer: HealthUtah PPO |
$66.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.47
|
| Rate for Payer: Multiplan Medicare/VA |
$35.99
|
| Rate for Payer: One Health Plan of WY PPO |
$65.13
|
| Rate for Payer: PacificSource Commercial |
$59.81
|
| Rate for Payer: PHCS PPO |
$65.13
|
| Rate for Payer: Three Rivers PPO |
$49.84
|
| Rate for Payer: TriWest Veterans Administration |
$37.88
|
| Rate for Payer: United Healthcare Commercial |
$63.47
|
| Rate for Payer: United Healthcare Medicare |
$37.88
|
| Rate for Payer: WINHealth Partners Commercial |
$65.13
|
| Rate for Payer: Wise Provider Network Commercial |
$63.14
|
|
|
ABDOMINAL BINDER LG 79-89327
|
Facility
|
IP
|
$39.66
|
|
| Hospital Charge Code |
2200232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.87
|
| Rate for Payer: Aetna of WY Medicare |
$25.38
|
| Rate for Payer: Altius Commercial |
$38.07
|
| Rate for Payer: Beech Street Commercial |
$38.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.47
|
| Rate for Payer: Cigna of WY Commercial |
$38.87
|
| Rate for Payer: Entrust Commercial |
$37.68
|
| Rate for Payer: First Choice Health Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.19
|
| Rate for Payer: HealthUtah PPO |
$39.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.47
|
| Rate for Payer: Multiplan Medicare/VA |
$22.98
|
| Rate for Payer: One Health Plan of WY PPO |
$38.87
|
| Rate for Payer: PacificSource Commercial |
$35.69
|
| Rate for Payer: PHCS PPO |
$38.87
|
| Rate for Payer: Three Rivers PPO |
$29.74
|
| Rate for Payer: TriWest Veterans Administration |
$24.19
|
| Rate for Payer: United Healthcare Commercial |
$37.88
|
| Rate for Payer: United Healthcare Medicare |
$24.19
|
| Rate for Payer: WINHealth Partners Commercial |
$37.68
|
| Rate for Payer: Wise Provider Network Commercial |
$37.68
|
|
|
ABDOMINAL BINDER LG 79-89327
|
Facility
|
OP
|
$39.66
|
|
| Hospital Charge Code |
2200232
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.87
|
| Rate for Payer: Aetna of WY Medicare |
$26.18
|
| Rate for Payer: Altius Commercial |
$38.07
|
| Rate for Payer: Beech Street Commercial |
$38.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.47
|
| Rate for Payer: Cigna of WY Commercial |
$38.87
|
| Rate for Payer: Entrust Commercial |
$37.68
|
| Rate for Payer: First Choice Health Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.61
|
| Rate for Payer: HealthUtah PPO |
$39.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.47
|
| Rate for Payer: Multiplan Medicare/VA |
$21.48
|
| Rate for Payer: One Health Plan of WY PPO |
$38.87
|
| Rate for Payer: PacificSource Commercial |
$35.69
|
| Rate for Payer: PHCS PPO |
$38.87
|
| Rate for Payer: Three Rivers PPO |
$29.74
|
| Rate for Payer: TriWest Veterans Administration |
$22.61
|
| Rate for Payer: United Healthcare Commercial |
$37.88
|
| Rate for Payer: United Healthcare Medicare |
$22.61
|
| Rate for Payer: WINHealth Partners Commercial |
$38.87
|
| Rate for Payer: Wise Provider Network Commercial |
$37.68
|
|
|
ABDOMINAL BINDER MED 79-89325
|
Facility
|
IP
|
$38.88
|
|
| Hospital Charge Code |
2200231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.53 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.10
|
| Rate for Payer: Aetna of WY Medicare |
$24.88
|
| Rate for Payer: Altius Commercial |
$37.32
|
| Rate for Payer: Beech Street Commercial |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.71
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.71
|
| Rate for Payer: Cigna of WY Commercial |
$38.10
|
| Rate for Payer: Entrust Commercial |
$36.94
|
| Rate for Payer: First Choice Health Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.72
|
| Rate for Payer: HealthUtah PPO |
$38.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.71
|
| Rate for Payer: Multiplan Medicare/VA |
$22.53
|
| Rate for Payer: One Health Plan of WY PPO |
$38.10
|
| Rate for Payer: PacificSource Commercial |
$34.99
|
| Rate for Payer: PHCS PPO |
$38.10
|
| Rate for Payer: Three Rivers PPO |
$29.16
|
| Rate for Payer: TriWest Veterans Administration |
$23.72
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$23.72
|
| Rate for Payer: WINHealth Partners Commercial |
$36.94
|
| Rate for Payer: Wise Provider Network Commercial |
$36.94
|
|
|
ABDOMINAL BINDER MED 79-89325
|
Facility
|
OP
|
$38.88
|
|
| Hospital Charge Code |
2200231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.10
|
| Rate for Payer: Aetna of WY Medicare |
$25.66
|
| Rate for Payer: Altius Commercial |
$37.32
|
| Rate for Payer: Beech Street Commercial |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.71
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.71
|
| Rate for Payer: Cigna of WY Commercial |
$38.10
|
| Rate for Payer: Entrust Commercial |
$36.94
|
| Rate for Payer: First Choice Health Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.16
|
| Rate for Payer: HealthUtah PPO |
$38.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.71
|
| Rate for Payer: Multiplan Medicare/VA |
$21.05
|
| Rate for Payer: One Health Plan of WY PPO |
$38.10
|
| Rate for Payer: PacificSource Commercial |
$34.99
|
| Rate for Payer: PHCS PPO |
$38.10
|
| Rate for Payer: Three Rivers PPO |
$29.16
|
| Rate for Payer: TriWest Veterans Administration |
$22.16
|
| Rate for Payer: United Healthcare Commercial |
$37.13
|
| Rate for Payer: United Healthcare Medicare |
$22.16
|
| Rate for Payer: WINHealth Partners Commercial |
$38.10
|
| Rate for Payer: Wise Provider Network Commercial |
$36.94
|
|
|
ABDOMINAL BINDER UNIV 79-89080
|
Facility
|
OP
|
$16.38
|
|
| Hospital Charge Code |
2200230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Aetna of WY Medicare |
$10.81
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.89
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.34
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$9.34
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare |
$9.34
|
| Rate for Payer: WINHealth Partners Commercial |
$16.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
ABDOMINAL BINDER UNIV 79-89080
|
Facility
|
IP
|
$16.38
|
|
| Hospital Charge Code |
2200230
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Aetna of WY Medicare |
$10.48
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.89
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.99
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.49
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$9.99
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$1,051.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,029.98
|
| Rate for Payer: Aetna of WY Medicare |
$100.45
|
| Rate for Payer: Beech Street Commercial |
$998.45
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: Cash Price |
$735.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,019.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,029.98
|
| Rate for Payer: First Choice Health Commercial |
$945.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$998.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.45
|
| Rate for Payer: HealthUtah PPO |
$1,051.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,019.47
|
| Rate for Payer: Multiplan Medicare/VA |
$85.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,029.98
|
| Rate for Payer: PacificSource Commercial |
$945.90
|
| Rate for Payer: PHCS PPO |
$998.45
|
| Rate for Payer: Three Rivers PPO |
$788.25
|
| Rate for Payer: TriWest Veterans Administration |
$100.45
|
| Rate for Payer: United Healthcare Commercial |
$998.45
|
| Rate for Payer: WINHealth Partners Commercial |
$893.35
|
|
|
ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Beech Street Commercial |
$311.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: First Choice Health Commercial |
$295.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.76
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$59.30
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$311.60
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$311.60
|
| Rate for Payer: WINHealth Partners Commercial |
$278.80
|
|
|
ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$1,493.25 |
| Max. Negotiated Rate |
$1,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,951.18
|
| Rate for Payer: Beech Street Commercial |
$1,891.45
|
| Rate for Payer: Cash Price |
$1,393.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,931.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,951.18
|
| Rate for Payer: First Choice Health Commercial |
$1,791.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,891.45
|
| Rate for Payer: HealthUtah PPO |
$1,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,931.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,951.18
|
| Rate for Payer: PacificSource Commercial |
$1,791.90
|
| Rate for Payer: PHCS PPO |
$1,891.45
|
| Rate for Payer: Three Rivers PPO |
$1,493.25
|
| Rate for Payer: United Healthcare Commercial |
$1,891.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,692.35
|
|
|
ABSORBATACK FIXATION DEVICE 15
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
2650565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.80
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$454.86
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$478.80
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
