OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL
|
Professional
|
Both
|
$4,841.00
|
|
Service Code
|
HCPCS 23485
|
Hospital Charge Code |
23485
|
Min. Negotiated Rate |
$782.56 |
Max. Negotiated Rate |
$4,841.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,744.18
|
Rate for Payer: Aetna of WY Medicare |
$920.66
|
Rate for Payer: Beech Street Commercial |
$4,598.95
|
Rate for Payer: Cash Price |
$3,388.70
|
Rate for Payer: Cash Price |
$3,388.70
|
Rate for Payer: ChoiceCare Network Commercial |
$4,695.77
|
Rate for Payer: Cigna of WY Commercial |
$4,744.18
|
Rate for Payer: First Choice Health Commercial |
$4,356.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,598.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$920.66
|
Rate for Payer: HealthUtah PPO |
$4,841.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,695.77
|
Rate for Payer: Multiplan Medicare/VA |
$782.56
|
Rate for Payer: One Health Plan of WY PPO |
$4,744.18
|
Rate for Payer: PacificSource Commercial |
$4,356.90
|
Rate for Payer: PHCS PPO |
$4,598.95
|
Rate for Payer: Three Rivers PPO |
$3,630.75
|
Rate for Payer: TriWest Veterans Administration |
$920.66
|
Rate for Payer: United Healthcare Commercial |
$4,211.67
|
Rate for Payer: United Healthcare Medicare |
$920.66
|
Rate for Payer: WINHealth Partners Commercial |
$4,114.85
|
|
OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$2,867.00
|
|
Service Code
|
HCPCS 24400 AS
|
Hospital Charge Code |
24400
|
Min. Negotiated Rate |
$682.73 |
Max. Negotiated Rate |
$2,867.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,809.66
|
Rate for Payer: Aetna of WY Medicare |
$803.21
|
Rate for Payer: Beech Street Commercial |
$2,723.65
|
Rate for Payer: Cash Price |
$2,006.90
|
Rate for Payer: Cash Price |
$2,006.90
|
Rate for Payer: ChoiceCare Network Commercial |
$2,780.99
|
Rate for Payer: Cigna of WY Commercial |
$2,809.66
|
Rate for Payer: First Choice Health Commercial |
$2,580.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,723.65
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$803.21
|
Rate for Payer: HealthUtah PPO |
$2,867.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,780.99
|
Rate for Payer: Multiplan Medicare/VA |
$682.73
|
Rate for Payer: One Health Plan of WY PPO |
$2,809.66
|
Rate for Payer: PacificSource Commercial |
$2,580.30
|
Rate for Payer: PHCS PPO |
$2,723.65
|
Rate for Payer: Three Rivers PPO |
$2,150.25
|
Rate for Payer: TriWest Veterans Administration |
$803.21
|
Rate for Payer: United Healthcare Commercial |
$2,494.29
|
Rate for Payer: United Healthcare Medicare |
$803.21
|
Rate for Payer: WINHealth Partners Commercial |
$2,436.95
|
|
OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION
|
Professional
|
Both
|
$2,867.00
|
|
Service Code
|
HCPCS 24400
|
Hospital Charge Code |
24400
|
Min. Negotiated Rate |
$682.73 |
Max. Negotiated Rate |
$2,867.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,809.66
|
Rate for Payer: Aetna of WY Medicare |
$803.21
|
Rate for Payer: Beech Street Commercial |
$2,723.65
|
Rate for Payer: Cash Price |
$2,006.90
|
Rate for Payer: Cash Price |
$2,006.90
|
Rate for Payer: ChoiceCare Network Commercial |
$2,780.99
|
Rate for Payer: Cigna of WY Commercial |
$2,809.66
|
Rate for Payer: First Choice Health Commercial |
$2,580.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,723.65
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$803.21
|
Rate for Payer: HealthUtah PPO |
$2,867.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,780.99
|
Rate for Payer: Multiplan Medicare/VA |
$682.73
|
Rate for Payer: One Health Plan of WY PPO |
$2,809.66
|
Rate for Payer: PacificSource Commercial |
$2,580.30
|
Rate for Payer: PHCS PPO |
$2,723.65
|
Rate for Payer: Three Rivers PPO |
$2,150.25
|
Rate for Payer: TriWest Veterans Administration |
$803.21
|
Rate for Payer: United Healthcare Commercial |
$2,494.29
|
Rate for Payer: United Healthcare Medicare |
$803.21
|
Rate for Payer: WINHealth Partners Commercial |
$2,436.95
|
|
OSTEOTOMY PHALANX FINGER EACH
|
Professional
|
Both
|
$5,517.00
|
|
Service Code
|
HCPCS 26567 AS
|
Hospital Charge Code |
26567
|
Min. Negotiated Rate |
$599.39 |
Max. Negotiated Rate |
$5,517.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,406.66
|
Rate for Payer: Aetna of WY Medicare |
$705.16
|
Rate for Payer: Beech Street Commercial |
$5,241.15
|
Rate for Payer: Cash Price |
$3,861.90
|
Rate for Payer: Cash Price |
$3,861.90
|
Rate for Payer: ChoiceCare Network Commercial |
$5,351.49
|
Rate for Payer: Cigna of WY Commercial |
$5,406.66
|
Rate for Payer: First Choice Health Commercial |
$4,965.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,241.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.16
|
Rate for Payer: HealthUtah PPO |
$5,517.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,351.49
|
Rate for Payer: Multiplan Medicare/VA |
$599.39
|
Rate for Payer: One Health Plan of WY PPO |
$5,406.66
|
Rate for Payer: PacificSource Commercial |
$4,965.30
|
Rate for Payer: PHCS PPO |
$5,241.15
|
Rate for Payer: Three Rivers PPO |
$4,137.75
|
Rate for Payer: TriWest Veterans Administration |
$705.16
|
Rate for Payer: United Healthcare Commercial |
$4,799.79
|
Rate for Payer: United Healthcare Medicare |
$705.16
|
Rate for Payer: WINHealth Partners Commercial |
$4,689.45
|
|
OSTEOTOMY PHALANX FINGER EACH
|
Professional
|
Both
|
$5,517.00
|
|
Service Code
|
HCPCS 26567
|
Hospital Charge Code |
26567
|
Min. Negotiated Rate |
$599.39 |
Max. Negotiated Rate |
$5,517.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,406.66
|
Rate for Payer: Aetna of WY Medicare |
$705.16
|
Rate for Payer: Beech Street Commercial |
$5,241.15
|
Rate for Payer: Cash Price |
$3,861.90
|
Rate for Payer: Cash Price |
$3,861.90
|
Rate for Payer: ChoiceCare Network Commercial |
$5,351.49
|
Rate for Payer: Cigna of WY Commercial |
$5,406.66
|
Rate for Payer: First Choice Health Commercial |
$4,965.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,241.15
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.16
|
Rate for Payer: HealthUtah PPO |
$5,517.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,351.49
|
Rate for Payer: Multiplan Medicare/VA |
$599.39
|
Rate for Payer: One Health Plan of WY PPO |
$5,406.66
|
Rate for Payer: PacificSource Commercial |
$4,965.30
|
Rate for Payer: PHCS PPO |
$5,241.15
|
Rate for Payer: Three Rivers PPO |
$4,137.75
|
Rate for Payer: TriWest Veterans Administration |
$705.16
|
Rate for Payer: United Healthcare Commercial |
$4,799.79
|
Rate for Payer: United Healthcare Medicare |
$705.16
|
Rate for Payer: WINHealth Partners Commercial |
$4,689.45
|
|
OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,289.00
|
|
Service Code
|
HCPCS 25360
|
Hospital Charge Code |
25360
|
Min. Negotiated Rate |
$544.99 |
Max. Negotiated Rate |
$2,289.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,243.22
|
Rate for Payer: Aetna of WY Medicare |
$641.17
|
Rate for Payer: Beech Street Commercial |
$2,174.55
|
Rate for Payer: Cash Price |
$1,602.30
|
Rate for Payer: Cash Price |
$1,602.30
|
Rate for Payer: ChoiceCare Network Commercial |
$2,220.33
|
Rate for Payer: Cigna of WY Commercial |
$2,243.22
|
Rate for Payer: First Choice Health Commercial |
$2,060.10
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,174.55
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$641.17
|
Rate for Payer: HealthUtah PPO |
$2,289.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,220.33
|
Rate for Payer: Multiplan Medicare/VA |
$544.99
|
Rate for Payer: One Health Plan of WY PPO |
$2,243.22
|
Rate for Payer: PacificSource Commercial |
$2,060.10
|
Rate for Payer: PHCS PPO |
$2,174.55
|
Rate for Payer: Three Rivers PPO |
$1,716.75
|
Rate for Payer: TriWest Veterans Administration |
$641.17
|
Rate for Payer: United Healthcare Commercial |
$1,991.43
|
Rate for Payer: United Healthcare Medicare |
$641.17
|
Rate for Payer: WINHealth Partners Commercial |
$1,945.65
|
|
OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,289.00
|
|
Service Code
|
HCPCS 25360 AS
|
Hospital Charge Code |
25360
|
Min. Negotiated Rate |
$544.99 |
Max. Negotiated Rate |
$2,289.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,243.22
|
Rate for Payer: Aetna of WY Medicare |
$641.17
|
Rate for Payer: Beech Street Commercial |
$2,174.55
|
Rate for Payer: Cash Price |
$1,602.30
|
Rate for Payer: Cash Price |
$1,602.30
|
Rate for Payer: ChoiceCare Network Commercial |
$2,220.33
|
Rate for Payer: Cigna of WY Commercial |
$2,243.22
|
Rate for Payer: First Choice Health Commercial |
$2,060.10
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,174.55
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$641.17
|
Rate for Payer: HealthUtah PPO |
$2,289.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,220.33
|
Rate for Payer: Multiplan Medicare/VA |
$544.99
|
Rate for Payer: One Health Plan of WY PPO |
$2,243.22
|
Rate for Payer: PacificSource Commercial |
$2,060.10
|
Rate for Payer: PHCS PPO |
$2,174.55
|
Rate for Payer: Three Rivers PPO |
$1,716.75
|
Rate for Payer: TriWest Veterans Administration |
$641.17
|
Rate for Payer: United Healthcare Commercial |
$1,991.43
|
Rate for Payer: United Healthcare Medicare |
$641.17
|
Rate for Payer: WINHealth Partners Commercial |
$1,945.65
|
|
OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$4,914.00
|
|
Service Code
|
HCPCS 27455
|
Hospital Charge Code |
27455
|
Min. Negotiated Rate |
$789.40 |
Max. Negotiated Rate |
$4,914.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,815.72
|
Rate for Payer: Aetna of WY Medicare |
$928.70
|
Rate for Payer: Beech Street Commercial |
$4,668.30
|
Rate for Payer: Cash Price |
$3,439.80
|
Rate for Payer: Cash Price |
$3,439.80
|
Rate for Payer: ChoiceCare Network Commercial |
$4,766.58
|
Rate for Payer: Cigna of WY Commercial |
$4,815.72
|
Rate for Payer: First Choice Health Commercial |
$4,422.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,668.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.70
|
Rate for Payer: HealthUtah PPO |
$4,914.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,766.58
|
Rate for Payer: Multiplan Medicare/VA |
$789.40
|
Rate for Payer: One Health Plan of WY PPO |
$4,815.72
|
Rate for Payer: PacificSource Commercial |
$4,422.60
|
Rate for Payer: PHCS PPO |
$4,668.30
|
Rate for Payer: Three Rivers PPO |
$3,685.50
|
Rate for Payer: TriWest Veterans Administration |
$928.70
|
Rate for Payer: United Healthcare Commercial |
$4,275.18
|
Rate for Payer: United Healthcare Medicare |
$928.70
|
Rate for Payer: WINHealth Partners Commercial |
$4,176.90
|
|
OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$4,914.00
|
|
Service Code
|
HCPCS 27455 AS
|
Hospital Charge Code |
27455
|
Min. Negotiated Rate |
$789.40 |
Max. Negotiated Rate |
$4,914.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,815.72
|
Rate for Payer: Aetna of WY Medicare |
$928.70
|
Rate for Payer: Beech Street Commercial |
$4,668.30
|
Rate for Payer: Cash Price |
$3,439.80
|
Rate for Payer: Cash Price |
$3,439.80
|
Rate for Payer: ChoiceCare Network Commercial |
$4,766.58
|
Rate for Payer: Cigna of WY Commercial |
$4,815.72
|
Rate for Payer: First Choice Health Commercial |
$4,422.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,668.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.70
|
Rate for Payer: HealthUtah PPO |
$4,914.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,766.58
|
Rate for Payer: Multiplan Medicare/VA |
$789.40
|
Rate for Payer: One Health Plan of WY PPO |
$4,815.72
|
Rate for Payer: PacificSource Commercial |
$4,422.60
|
Rate for Payer: PHCS PPO |
$4,668.30
|
Rate for Payer: Three Rivers PPO |
$3,685.50
|
Rate for Payer: TriWest Veterans Administration |
$928.70
|
Rate for Payer: United Healthcare Commercial |
$4,275.18
|
Rate for Payer: United Healthcare Medicare |
$928.70
|
Rate for Payer: WINHealth Partners Commercial |
$4,176.90
|
|
OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$249.00
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
92502
|
Min. Negotiated Rate |
$78.60 |
Max. Negotiated Rate |
$249.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.02
|
Rate for Payer: Aetna of WY Medicare |
$92.47
|
Rate for Payer: Beech Street Commercial |
$236.55
|
Rate for Payer: Cash Price |
$174.30
|
Rate for Payer: Cash Price |
$174.30
|
Rate for Payer: ChoiceCare Network Commercial |
$241.53
|
Rate for Payer: Cigna of WY Commercial |
$244.02
|
Rate for Payer: First Choice Health Commercial |
$224.10
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.55
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.47
|
Rate for Payer: HealthUtah PPO |
$249.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.53
|
Rate for Payer: Multiplan Medicare/VA |
$78.60
|
Rate for Payer: One Health Plan of WY PPO |
$244.02
|
Rate for Payer: PacificSource Commercial |
$224.10
|
Rate for Payer: PHCS PPO |
$236.55
|
Rate for Payer: Three Rivers PPO |
$186.75
|
Rate for Payer: TriWest Veterans Administration |
$92.47
|
Rate for Payer: United Healthcare Commercial |
$216.63
|
Rate for Payer: United Healthcare Medicare |
$92.47
|
Rate for Payer: WINHealth Partners Commercial |
$236.55
|
|
OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$3,928.00
|
|
Service Code
|
HCPCS 58925
|
Hospital Charge Code |
58925
|
Min. Negotiated Rate |
$627.67 |
Max. Negotiated Rate |
$3,928.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,849.44
|
Rate for Payer: Aetna of WY Medicare |
$738.44
|
Rate for Payer: Beech Street Commercial |
$3,731.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: ChoiceCare Network Commercial |
$3,810.16
|
Rate for Payer: Cigna of WY Commercial |
$3,849.44
|
Rate for Payer: First Choice Health Commercial |
$3,535.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,731.60
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.44
|
Rate for Payer: HealthUtah PPO |
$3,928.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,810.16
|
Rate for Payer: Multiplan Medicare/VA |
$627.67
|
Rate for Payer: One Health Plan of WY PPO |
$3,849.44
|
Rate for Payer: PacificSource Commercial |
$3,535.20
|
Rate for Payer: PHCS PPO |
$3,731.60
|
Rate for Payer: Three Rivers PPO |
$2,946.00
|
Rate for Payer: TriWest Veterans Administration |
$738.44
|
Rate for Payer: United Healthcare Commercial |
$3,417.36
|
Rate for Payer: United Healthcare Medicare |
$738.44
|
Rate for Payer: WINHealth Partners Commercial |
$3,338.80
|
|
OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$3,928.00
|
|
Service Code
|
HCPCS 58925 80
|
Hospital Charge Code |
58925
|
Min. Negotiated Rate |
$627.67 |
Max. Negotiated Rate |
$3,928.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,849.44
|
Rate for Payer: Aetna of WY Medicare |
$738.44
|
Rate for Payer: Beech Street Commercial |
$3,731.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: ChoiceCare Network Commercial |
$3,810.16
|
Rate for Payer: Cigna of WY Commercial |
$3,849.44
|
Rate for Payer: First Choice Health Commercial |
$3,535.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,731.60
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.44
|
Rate for Payer: HealthUtah PPO |
$3,928.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,810.16
|
Rate for Payer: Multiplan Medicare/VA |
$627.67
|
Rate for Payer: One Health Plan of WY PPO |
$3,849.44
|
Rate for Payer: PacificSource Commercial |
$3,535.20
|
Rate for Payer: PHCS PPO |
$3,731.60
|
Rate for Payer: Three Rivers PPO |
$2,946.00
|
Rate for Payer: TriWest Veterans Administration |
$738.44
|
Rate for Payer: United Healthcare Commercial |
$3,417.36
|
Rate for Payer: United Healthcare Medicare |
$738.44
|
Rate for Payer: WINHealth Partners Commercial |
$3,338.80
|
|
OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$3,928.00
|
|
Service Code
|
HCPCS 58925 AS
|
Hospital Charge Code |
58925
|
Min. Negotiated Rate |
$627.67 |
Max. Negotiated Rate |
$3,928.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,849.44
|
Rate for Payer: Aetna of WY Medicare |
$738.44
|
Rate for Payer: Beech Street Commercial |
$3,731.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: Cash Price |
$2,749.60
|
Rate for Payer: ChoiceCare Network Commercial |
$3,810.16
|
Rate for Payer: Cigna of WY Commercial |
$3,849.44
|
Rate for Payer: First Choice Health Commercial |
$3,535.20
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,731.60
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.44
|
Rate for Payer: HealthUtah PPO |
$3,928.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,810.16
|
Rate for Payer: Multiplan Medicare/VA |
$627.67
|
Rate for Payer: One Health Plan of WY PPO |
$3,849.44
|
Rate for Payer: PacificSource Commercial |
$3,535.20
|
Rate for Payer: PHCS PPO |
$3,731.60
|
Rate for Payer: Three Rivers PPO |
$2,946.00
|
Rate for Payer: TriWest Veterans Administration |
$738.44
|
Rate for Payer: United Healthcare Commercial |
$3,417.36
|
Rate for Payer: United Healthcare Medicare |
$738.44
|
Rate for Payer: WINHealth Partners Commercial |
$3,338.80
|
|
OXALIPLATIN 5 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000711]
|
Facility
|
OP
|
$19.00
|
|
Service Code
|
HCPCS J9263
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.47 |
Max. Negotiated Rate |
$19.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
Rate for Payer: Aetna of WY Medicare |
$12.54
|
Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
Rate for Payer: Altius Commercial |
$18.24
|
Rate for Payer: Beech Street Commercial |
$18.62
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
Rate for Payer: Cash Price |
$13.30
|
Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
Rate for Payer: Cigna of WY Commercial |
$18.62
|
Rate for Payer: Entrust Commercial |
$18.05
|
Rate for Payer: First Choice Health Commercial |
$18.05
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
Rate for Payer: HealthUtah PPO |
$19.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
Rate for Payer: Multiplan Medicare/VA |
$10.47
|
Rate for Payer: One Health Plan of WY PPO |
$18.62
|
Rate for Payer: PacificSource Commercial |
$17.10
|
Rate for Payer: PHCS PPO |
$18.62
|
Rate for Payer: Three Rivers PPO |
$14.25
|
Rate for Payer: TriWest Veterans Administration |
$11.02
|
Rate for Payer: United Healthcare Commercial |
$16.53
|
Rate for Payer: United Healthcare Medicare |
$11.02
|
Rate for Payer: WINHealth Partners Commercial |
$18.62
|
Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
OXALIPLATIN 5 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000711]
|
Facility
|
IP
|
$19.00
|
|
Service Code
|
HCPCS J9263
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.91 |
Max. Negotiated Rate |
$19.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
Rate for Payer: Altius Commercial |
$18.24
|
Rate for Payer: Beech Street Commercial |
$18.62
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
Rate for Payer: Cash Price |
$13.30
|
Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
Rate for Payer: Cigna of WY Commercial |
$18.62
|
Rate for Payer: Entrust Commercial |
$18.05
|
Rate for Payer: First Choice Health Commercial |
$18.05
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
Rate for Payer: HealthUtah PPO |
$19.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
Rate for Payer: Multiplan Medicare/VA |
$11.91
|
Rate for Payer: One Health Plan of WY PPO |
$18.62
|
Rate for Payer: PacificSource Commercial |
$17.10
|
Rate for Payer: PHCS PPO |
$18.62
|
Rate for Payer: Three Rivers PPO |
$14.25
|
Rate for Payer: TriWest Veterans Administration |
$12.54
|
Rate for Payer: United Healthcare Commercial |
$16.53
|
Rate for Payer: United Healthcare Medicare |
$12.54
|
Rate for Payer: WINHealth Partners Commercial |
$18.05
|
Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
OXCARBAZEPINE 300 MG TABLET [6906]
|
Facility
|
OP
|
$2.20
|
|
Service Code
|
NDC 6846213801
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.21 |
Max. Negotiated Rate |
$2.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.16
|
Rate for Payer: Aetna of WY Medicare |
$1.45
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.11
|
Rate for Payer: Altius Commercial |
$2.11
|
Rate for Payer: Beech Street Commercial |
$2.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.81
|
Rate for Payer: Cash Price |
$1.54
|
Rate for Payer: ChoiceCare Network Commercial |
$2.13
|
Rate for Payer: Cigna of WY Commercial |
$2.16
|
Rate for Payer: Entrust Commercial |
$2.09
|
Rate for Payer: First Choice Health Commercial |
$2.09
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.09
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.28
|
Rate for Payer: HealthUtah PPO |
$2.20
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.13
|
Rate for Payer: Multiplan Medicare/VA |
$1.21
|
Rate for Payer: One Health Plan of WY PPO |
$2.16
|
Rate for Payer: PacificSource Commercial |
$1.98
|
Rate for Payer: PHCS PPO |
$2.16
|
Rate for Payer: Three Rivers PPO |
$1.65
|
Rate for Payer: TriWest Veterans Administration |
$1.28
|
Rate for Payer: United Healthcare Commercial |
$1.91
|
Rate for Payer: United Healthcare Medicare |
$1.28
|
Rate for Payer: WINHealth Partners Commercial |
$2.16
|
Rate for Payer: Wise Provider Network Commercial |
$2.09
|
|
OXCARBAZEPINE 300 MG TABLET [6906]
|
Facility
|
IP
|
$2.20
|
|
Service Code
|
NDC 6846213801
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.38 |
Max. Negotiated Rate |
$2.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.16
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.11
|
Rate for Payer: Altius Commercial |
$2.11
|
Rate for Payer: Beech Street Commercial |
$2.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.81
|
Rate for Payer: Cash Price |
$1.54
|
Rate for Payer: ChoiceCare Network Commercial |
$2.13
|
Rate for Payer: Cigna of WY Commercial |
$2.16
|
Rate for Payer: Entrust Commercial |
$2.09
|
Rate for Payer: First Choice Health Commercial |
$2.09
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.09
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.45
|
Rate for Payer: HealthUtah PPO |
$2.20
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.13
|
Rate for Payer: Multiplan Medicare/VA |
$1.38
|
Rate for Payer: One Health Plan of WY PPO |
$2.16
|
Rate for Payer: PacificSource Commercial |
$1.98
|
Rate for Payer: PHCS PPO |
$2.16
|
Rate for Payer: Three Rivers PPO |
$1.65
|
Rate for Payer: TriWest Veterans Administration |
$1.45
|
Rate for Payer: United Healthcare Commercial |
$1.91
|
Rate for Payer: United Healthcare Medicare |
$1.45
|
Rate for Payer: WINHealth Partners Commercial |
$2.09
|
Rate for Payer: Wise Provider Network Commercial |
$2.09
|
|
OXIMAX-A ADULT DISPOSABLE
|
Facility
|
OP
|
$16.91
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.32 |
Max. Negotiated Rate |
$16.91 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
Rate for Payer: Aetna of WY Medicare |
$11.16
|
Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
Rate for Payer: Altius Commercial |
$16.23
|
Rate for Payer: Beech Street Commercial |
$16.57
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
Rate for Payer: Cash Price |
$11.83
|
Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
Rate for Payer: Cigna of WY Commercial |
$16.57
|
Rate for Payer: Entrust Commercial |
$16.06
|
Rate for Payer: First Choice Health Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
Rate for Payer: HealthUtah PPO |
$16.91
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
Rate for Payer: Multiplan Medicare/VA |
$9.32
|
Rate for Payer: One Health Plan of WY PPO |
$16.57
|
Rate for Payer: PacificSource Commercial |
$15.22
|
Rate for Payer: PHCS PPO |
$16.57
|
Rate for Payer: Three Rivers PPO |
$12.68
|
Rate for Payer: TriWest Veterans Administration |
$9.81
|
Rate for Payer: United Healthcare Commercial |
$14.71
|
Rate for Payer: United Healthcare Medicare |
$9.81
|
Rate for Payer: WINHealth Partners Commercial |
$16.57
|
Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
OXIMAX-A ADULT DISPOSABLE
|
Facility
|
IP
|
$16.91
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$10.60 |
Max. Negotiated Rate |
$16.91 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
Rate for Payer: Altius Commercial |
$16.23
|
Rate for Payer: Beech Street Commercial |
$16.57
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
Rate for Payer: Cash Price |
$11.83
|
Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
Rate for Payer: Cigna of WY Commercial |
$16.57
|
Rate for Payer: Entrust Commercial |
$16.06
|
Rate for Payer: First Choice Health Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.16
|
Rate for Payer: HealthUtah PPO |
$16.91
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
Rate for Payer: Multiplan Medicare/VA |
$10.60
|
Rate for Payer: One Health Plan of WY PPO |
$16.57
|
Rate for Payer: PacificSource Commercial |
$15.22
|
Rate for Payer: PHCS PPO |
$16.57
|
Rate for Payer: Three Rivers PPO |
$12.68
|
Rate for Payer: TriWest Veterans Administration |
$11.16
|
Rate for Payer: United Healthcare Commercial |
$14.71
|
Rate for Payer: United Healthcare Medicare |
$11.16
|
Rate for Payer: WINHealth Partners Commercial |
$16.06
|
Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
OXIMAX-I INFANT DISPOSABLE
|
Facility
|
OP
|
$17.75
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.78 |
Max. Negotiated Rate |
$17.75 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.40
|
Rate for Payer: Aetna of WY Medicare |
$11.72
|
Rate for Payer: Altius Auto/Workers Compensation |
$17.04
|
Rate for Payer: Altius Commercial |
$17.04
|
Rate for Payer: Beech Street Commercial |
$17.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
Rate for Payer: Cash Price |
$12.42
|
Rate for Payer: ChoiceCare Network Commercial |
$17.22
|
Rate for Payer: Cigna of WY Commercial |
$17.40
|
Rate for Payer: Entrust Commercial |
$16.86
|
Rate for Payer: First Choice Health Commercial |
$16.86
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.86
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
Rate for Payer: HealthUtah PPO |
$17.75
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.22
|
Rate for Payer: Multiplan Medicare/VA |
$9.78
|
Rate for Payer: One Health Plan of WY PPO |
$17.40
|
Rate for Payer: PacificSource Commercial |
$15.98
|
Rate for Payer: PHCS PPO |
$17.40
|
Rate for Payer: Three Rivers PPO |
$13.31
|
Rate for Payer: TriWest Veterans Administration |
$10.30
|
Rate for Payer: United Healthcare Commercial |
$15.44
|
Rate for Payer: United Healthcare Medicare |
$10.30
|
Rate for Payer: WINHealth Partners Commercial |
$17.40
|
Rate for Payer: Wise Provider Network Commercial |
$16.86
|
|
OXIMAX-I INFANT DISPOSABLE
|
Facility
|
IP
|
$17.75
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$11.13 |
Max. Negotiated Rate |
$17.75 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$17.04
|
Rate for Payer: Altius Commercial |
$17.04
|
Rate for Payer: Beech Street Commercial |
$17.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
Rate for Payer: Cash Price |
$12.42
|
Rate for Payer: ChoiceCare Network Commercial |
$17.22
|
Rate for Payer: Cigna of WY Commercial |
$17.40
|
Rate for Payer: Entrust Commercial |
$16.86
|
Rate for Payer: First Choice Health Commercial |
$16.86
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.86
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.72
|
Rate for Payer: HealthUtah PPO |
$17.75
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.22
|
Rate for Payer: Multiplan Medicare/VA |
$11.13
|
Rate for Payer: One Health Plan of WY PPO |
$17.40
|
Rate for Payer: PacificSource Commercial |
$15.98
|
Rate for Payer: PHCS PPO |
$17.40
|
Rate for Payer: Three Rivers PPO |
$13.31
|
Rate for Payer: TriWest Veterans Administration |
$11.72
|
Rate for Payer: United Healthcare Commercial |
$15.44
|
Rate for Payer: United Healthcare Medicare |
$11.72
|
Rate for Payer: WINHealth Partners Commercial |
$16.86
|
Rate for Payer: Wise Provider Network Commercial |
$16.86
|
|
OXIMAX-N NEONATAL ADULT DISPOSABLE
|
Facility
|
IP
|
$17.92
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$11.24 |
Max. Negotiated Rate |
$17.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.56
|
Rate for Payer: Altius Auto/Workers Compensation |
$17.20
|
Rate for Payer: Altius Commercial |
$17.20
|
Rate for Payer: Beech Street Commercial |
$17.56
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
Rate for Payer: Cash Price |
$12.54
|
Rate for Payer: ChoiceCare Network Commercial |
$17.38
|
Rate for Payer: Cigna of WY Commercial |
$17.56
|
Rate for Payer: Entrust Commercial |
$17.02
|
Rate for Payer: First Choice Health Commercial |
$17.02
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.02
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.83
|
Rate for Payer: HealthUtah PPO |
$17.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.38
|
Rate for Payer: Multiplan Medicare/VA |
$11.24
|
Rate for Payer: One Health Plan of WY PPO |
$17.56
|
Rate for Payer: PacificSource Commercial |
$16.13
|
Rate for Payer: PHCS PPO |
$17.56
|
Rate for Payer: Three Rivers PPO |
$13.44
|
Rate for Payer: TriWest Veterans Administration |
$11.83
|
Rate for Payer: United Healthcare Commercial |
$15.59
|
Rate for Payer: United Healthcare Medicare |
$11.83
|
Rate for Payer: WINHealth Partners Commercial |
$17.02
|
Rate for Payer: Wise Provider Network Commercial |
$17.02
|
|
OXIMAX-N NEONATAL ADULT DISPOSABLE
|
Facility
|
OP
|
$17.92
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.87 |
Max. Negotiated Rate |
$17.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.56
|
Rate for Payer: Aetna of WY Medicare |
$11.83
|
Rate for Payer: Altius Auto/Workers Compensation |
$17.20
|
Rate for Payer: Altius Commercial |
$17.20
|
Rate for Payer: Beech Street Commercial |
$17.56
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
Rate for Payer: Cash Price |
$12.54
|
Rate for Payer: ChoiceCare Network Commercial |
$17.38
|
Rate for Payer: Cigna of WY Commercial |
$17.56
|
Rate for Payer: Entrust Commercial |
$17.02
|
Rate for Payer: First Choice Health Commercial |
$17.02
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.02
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.39
|
Rate for Payer: HealthUtah PPO |
$17.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.38
|
Rate for Payer: Multiplan Medicare/VA |
$9.87
|
Rate for Payer: One Health Plan of WY PPO |
$17.56
|
Rate for Payer: PacificSource Commercial |
$16.13
|
Rate for Payer: PHCS PPO |
$17.56
|
Rate for Payer: Three Rivers PPO |
$13.44
|
Rate for Payer: TriWest Veterans Administration |
$10.39
|
Rate for Payer: United Healthcare Commercial |
$15.59
|
Rate for Payer: United Healthcare Medicare |
$10.39
|
Rate for Payer: WINHealth Partners Commercial |
$17.56
|
Rate for Payer: Wise Provider Network Commercial |
$17.02
|
|
OXIMAX-P PEDIATRIC DISPOSABLE
|
Facility
|
IP
|
$16.91
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$10.60 |
Max. Negotiated Rate |
$16.91 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
Rate for Payer: Altius Commercial |
$16.23
|
Rate for Payer: Beech Street Commercial |
$16.57
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
Rate for Payer: Cash Price |
$11.83
|
Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
Rate for Payer: Cigna of WY Commercial |
$16.57
|
Rate for Payer: Entrust Commercial |
$16.06
|
Rate for Payer: First Choice Health Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.16
|
Rate for Payer: HealthUtah PPO |
$16.91
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
Rate for Payer: Multiplan Medicare/VA |
$10.60
|
Rate for Payer: One Health Plan of WY PPO |
$16.57
|
Rate for Payer: PacificSource Commercial |
$15.22
|
Rate for Payer: PHCS PPO |
$16.57
|
Rate for Payer: Three Rivers PPO |
$12.68
|
Rate for Payer: TriWest Veterans Administration |
$11.16
|
Rate for Payer: United Healthcare Commercial |
$14.71
|
Rate for Payer: United Healthcare Medicare |
$11.16
|
Rate for Payer: WINHealth Partners Commercial |
$16.06
|
Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
OXIMAX-P PEDIATRIC DISPOSABLE
|
Facility
|
OP
|
$16.91
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$9.32 |
Max. Negotiated Rate |
$16.91 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
Rate for Payer: Aetna of WY Medicare |
$11.16
|
Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
Rate for Payer: Altius Commercial |
$16.23
|
Rate for Payer: Beech Street Commercial |
$16.57
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
Rate for Payer: Cash Price |
$11.83
|
Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
Rate for Payer: Cigna of WY Commercial |
$16.57
|
Rate for Payer: Entrust Commercial |
$16.06
|
Rate for Payer: First Choice Health Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
Rate for Payer: HealthUtah PPO |
$16.91
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
Rate for Payer: Multiplan Medicare/VA |
$9.32
|
Rate for Payer: One Health Plan of WY PPO |
$16.57
|
Rate for Payer: PacificSource Commercial |
$15.22
|
Rate for Payer: PHCS PPO |
$16.57
|
Rate for Payer: Three Rivers PPO |
$12.68
|
Rate for Payer: TriWest Veterans Administration |
$9.81
|
Rate for Payer: United Healthcare Commercial |
$14.71
|
Rate for Payer: United Healthcare Medicare |
$9.81
|
Rate for Payer: WINHealth Partners Commercial |
$16.57
|
Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|