|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [25715]
|
Facility
|
IP
|
$266.62
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.17 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$261.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.96
|
| Rate for Payer: Altius Commercial |
$255.96
|
| Rate for Payer: Beech Street Commercial |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.90
|
| Rate for Payer: Cash Price |
$186.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.62
|
| Rate for Payer: Cigna of WY Commercial |
$261.29
|
| Rate for Payer: Entrust Commercial |
$253.29
|
| Rate for Payer: First Choice Health Commercial |
$253.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.97
|
| Rate for Payer: HealthUtah PPO |
$266.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.62
|
| Rate for Payer: Multiplan Medicare/VA |
$167.17
|
| Rate for Payer: One Health Plan of WY PPO |
$261.29
|
| Rate for Payer: PacificSource Commercial |
$239.96
|
| Rate for Payer: PHCS PPO |
$261.29
|
| Rate for Payer: Three Rivers PPO |
$199.96
|
| Rate for Payer: TriWest Veterans Administration |
$175.97
|
| Rate for Payer: United Healthcare Commercial |
$231.96
|
| Rate for Payer: United Healthcare Medicare |
$175.97
|
| Rate for Payer: WINHealth Partners Commercial |
$253.29
|
| Rate for Payer: Wise Provider Network Commercial |
$253.29
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE [25715]
|
Facility
|
OP
|
$266.62
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.91 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$261.29
|
| Rate for Payer: Aetna of WY Medicare |
$175.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.96
|
| Rate for Payer: Altius Commercial |
$255.96
|
| Rate for Payer: Beech Street Commercial |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.90
|
| Rate for Payer: Cash Price |
$186.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.62
|
| Rate for Payer: Cigna of WY Commercial |
$261.29
|
| Rate for Payer: Entrust Commercial |
$253.29
|
| Rate for Payer: First Choice Health Commercial |
$253.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.64
|
| Rate for Payer: HealthUtah PPO |
$266.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.62
|
| Rate for Payer: Multiplan Medicare/VA |
$146.91
|
| Rate for Payer: One Health Plan of WY PPO |
$261.29
|
| Rate for Payer: PacificSource Commercial |
$239.96
|
| Rate for Payer: PHCS PPO |
$261.29
|
| Rate for Payer: Three Rivers PPO |
$199.96
|
| Rate for Payer: TriWest Veterans Administration |
$154.64
|
| Rate for Payer: United Healthcare Commercial |
$231.96
|
| Rate for Payer: United Healthcare Medicare |
$154.64
|
| Rate for Payer: WINHealth Partners Commercial |
$261.29
|
| Rate for Payer: Wise Provider Network Commercial |
$253.29
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [16531]
|
Facility
|
OP
|
$305.56
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$305.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$299.45
|
| Rate for Payer: Aetna of WY Medicare |
$201.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$293.34
|
| Rate for Payer: Altius Commercial |
$293.34
|
| Rate for Payer: Beech Street Commercial |
$299.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.86
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$296.39
|
| Rate for Payer: Cigna of WY Commercial |
$299.45
|
| Rate for Payer: Entrust Commercial |
$290.28
|
| Rate for Payer: First Choice Health Commercial |
$290.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$290.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.22
|
| Rate for Payer: HealthUtah PPO |
$305.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$296.39
|
| Rate for Payer: Multiplan Medicare/VA |
$168.36
|
| Rate for Payer: One Health Plan of WY PPO |
$299.45
|
| Rate for Payer: PacificSource Commercial |
$275.00
|
| Rate for Payer: PHCS PPO |
$299.45
|
| Rate for Payer: Three Rivers PPO |
$229.17
|
| Rate for Payer: TriWest Veterans Administration |
$177.22
|
| Rate for Payer: United Healthcare Commercial |
$265.84
|
| Rate for Payer: United Healthcare Medicare |
$177.22
|
| Rate for Payer: WINHealth Partners Commercial |
$299.45
|
| Rate for Payer: Wise Provider Network Commercial |
$290.28
|
|
|
PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE [16531]
|
Facility
|
IP
|
$305.56
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$305.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$299.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$293.34
|
| Rate for Payer: Altius Commercial |
$293.34
|
| Rate for Payer: Beech Street Commercial |
$299.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.86
|
| Rate for Payer: Cash Price |
$213.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$296.39
|
| Rate for Payer: Cigna of WY Commercial |
$299.45
|
| Rate for Payer: Entrust Commercial |
$290.28
|
| Rate for Payer: First Choice Health Commercial |
$290.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$290.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.67
|
| Rate for Payer: HealthUtah PPO |
$305.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$296.39
|
| Rate for Payer: Multiplan Medicare/VA |
$191.59
|
| Rate for Payer: One Health Plan of WY PPO |
$299.45
|
| Rate for Payer: PacificSource Commercial |
$275.00
|
| Rate for Payer: PHCS PPO |
$299.45
|
| Rate for Payer: Three Rivers PPO |
$229.17
|
| Rate for Payer: TriWest Veterans Administration |
$201.67
|
| Rate for Payer: United Healthcare Commercial |
$265.84
|
| Rate for Payer: United Healthcare Medicare |
$201.67
|
| Rate for Payer: WINHealth Partners Commercial |
$290.28
|
| Rate for Payer: Wise Provider Network Commercial |
$290.28
|
|
|
PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
J0561
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$22.00
|
| Rate for Payer: Beech Street Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: First Choice Health Commercial |
$20.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.00
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$18.70
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$21.85
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [4058]
|
Facility
|
IP
|
$50.61
|
|
|
Service Code
|
HCPCS J2540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$50.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.98
|
| Rate for Payer: Altius Commercial |
$47.98
|
| Rate for Payer: Altius Commercial |
$48.59
|
| Rate for Payer: Beech Street Commercial |
$49.60
|
| Rate for Payer: Beech Street Commercial |
$48.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.55
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.09
|
| Rate for Payer: Cigna of WY Commercial |
$49.60
|
| Rate for Payer: Cigna of WY Commercial |
$48.98
|
| Rate for Payer: Entrust Commercial |
$47.48
|
| Rate for Payer: Entrust Commercial |
$48.08
|
| Rate for Payer: First Choice Health Commercial |
$47.48
|
| Rate for Payer: First Choice Health Commercial |
$48.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.99
|
| Rate for Payer: HealthUtah PPO |
$50.61
|
| Rate for Payer: HealthUtah PPO |
$49.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.09
|
| Rate for Payer: Multiplan Medicare/VA |
$31.73
|
| Rate for Payer: Multiplan Medicare/VA |
$31.34
|
| Rate for Payer: One Health Plan of WY PPO |
$49.60
|
| Rate for Payer: One Health Plan of WY PPO |
$48.98
|
| Rate for Payer: PacificSource Commercial |
$45.55
|
| Rate for Payer: PacificSource Commercial |
$44.98
|
| Rate for Payer: PHCS PPO |
$48.98
|
| Rate for Payer: PHCS PPO |
$49.60
|
| Rate for Payer: Three Rivers PPO |
$37.48
|
| Rate for Payer: Three Rivers PPO |
$37.96
|
| Rate for Payer: TriWest Veterans Administration |
$33.40
|
| Rate for Payer: TriWest Veterans Administration |
$32.99
|
| Rate for Payer: United Healthcare Commercial |
$43.48
|
| Rate for Payer: United Healthcare Commercial |
$44.03
|
| Rate for Payer: United Healthcare Medicare |
$33.40
|
| Rate for Payer: United Healthcare Medicare |
$32.99
|
| Rate for Payer: WINHealth Partners Commercial |
$47.48
|
| Rate for Payer: WINHealth Partners Commercial |
$48.08
|
| Rate for Payer: Wise Provider Network Commercial |
$47.48
|
| Rate for Payer: Wise Provider Network Commercial |
$48.08
|
|
|
PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION [4058]
|
Facility
|
OP
|
$50.61
|
|
|
Service Code
|
HCPCS J2540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$50.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.60
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.40
|
| Rate for Payer: Aetna of WY Medicare |
$32.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.59
|
| Rate for Payer: Altius Commercial |
$48.59
|
| Rate for Payer: Altius Commercial |
$47.98
|
| Rate for Payer: Beech Street Commercial |
$48.98
|
| Rate for Payer: Beech Street Commercial |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.03
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.48
|
| Rate for Payer: Cigna of WY Commercial |
$48.98
|
| Rate for Payer: Cigna of WY Commercial |
$49.60
|
| Rate for Payer: Entrust Commercial |
$48.08
|
| Rate for Payer: Entrust Commercial |
$47.48
|
| Rate for Payer: First Choice Health Commercial |
$47.48
|
| Rate for Payer: First Choice Health Commercial |
$48.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.99
|
| Rate for Payer: HealthUtah PPO |
$49.98
|
| Rate for Payer: HealthUtah PPO |
$50.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.09
|
| Rate for Payer: Multiplan Medicare/VA |
$27.89
|
| Rate for Payer: Multiplan Medicare/VA |
$27.54
|
| Rate for Payer: One Health Plan of WY PPO |
$48.98
|
| Rate for Payer: One Health Plan of WY PPO |
$49.60
|
| Rate for Payer: PacificSource Commercial |
$45.55
|
| Rate for Payer: PacificSource Commercial |
$44.98
|
| Rate for Payer: PHCS PPO |
$48.98
|
| Rate for Payer: PHCS PPO |
$49.60
|
| Rate for Payer: Three Rivers PPO |
$37.48
|
| Rate for Payer: Three Rivers PPO |
$37.96
|
| Rate for Payer: TriWest Veterans Administration |
$29.35
|
| Rate for Payer: TriWest Veterans Administration |
$28.99
|
| Rate for Payer: United Healthcare Commercial |
$43.48
|
| Rate for Payer: United Healthcare Commercial |
$44.03
|
| Rate for Payer: United Healthcare Medicare |
$29.35
|
| Rate for Payer: United Healthcare Medicare |
$28.99
|
| Rate for Payer: WINHealth Partners Commercial |
$48.98
|
| Rate for Payer: WINHealth Partners Commercial |
$49.60
|
| Rate for Payer: Wise Provider Network Commercial |
$47.48
|
| Rate for Payer: Wise Provider Network Commercial |
$48.08
|
|
|
PENLIGHT BLU SPOT 8320150
|
Facility
|
OP
|
$82.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$82.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.09
|
| Rate for Payer: Aetna of WY Medicare |
$54.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.43
|
| Rate for Payer: Altius Commercial |
$79.43
|
| Rate for Payer: Beech Street Commercial |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.26
|
| Rate for Payer: Cigna of WY Commercial |
$81.09
|
| Rate for Payer: Entrust Commercial |
$78.60
|
| Rate for Payer: First Choice Health Commercial |
$78.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.99
|
| Rate for Payer: HealthUtah PPO |
$82.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.26
|
| Rate for Payer: Multiplan Medicare/VA |
$45.59
|
| Rate for Payer: One Health Plan of WY PPO |
$81.09
|
| Rate for Payer: PacificSource Commercial |
$74.47
|
| Rate for Payer: PHCS PPO |
$81.09
|
| Rate for Payer: Three Rivers PPO |
$62.06
|
| Rate for Payer: TriWest Veterans Administration |
$47.99
|
| Rate for Payer: United Healthcare Commercial |
$71.98
|
| Rate for Payer: United Healthcare Medicare |
$47.99
|
| Rate for Payer: WINHealth Partners Commercial |
$81.09
|
| Rate for Payer: Wise Provider Network Commercial |
$78.60
|
|
|
PENLIGHT BLU SPOT 8320150
|
Facility
|
IP
|
$82.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$82.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.43
|
| Rate for Payer: Altius Commercial |
$79.43
|
| Rate for Payer: Beech Street Commercial |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.26
|
| Rate for Payer: Cigna of WY Commercial |
$81.09
|
| Rate for Payer: Entrust Commercial |
$78.60
|
| Rate for Payer: First Choice Health Commercial |
$78.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.61
|
| Rate for Payer: HealthUtah PPO |
$82.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.26
|
| Rate for Payer: Multiplan Medicare/VA |
$51.88
|
| Rate for Payer: One Health Plan of WY PPO |
$81.09
|
| Rate for Payer: PacificSource Commercial |
$74.47
|
| Rate for Payer: PHCS PPO |
$81.09
|
| Rate for Payer: Three Rivers PPO |
$62.06
|
| Rate for Payer: TriWest Veterans Administration |
$54.61
|
| Rate for Payer: United Healthcare Commercial |
$71.98
|
| Rate for Payer: United Healthcare Medicare |
$54.61
|
| Rate for Payer: WINHealth Partners Commercial |
$78.60
|
| Rate for Payer: Wise Provider Network Commercial |
$78.60
|
|
|
PEN NEEDLE,DIABETIC DUAL SAFETY 30 GAUGE X 3/16" [94454]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 8470795501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.13
|
| Rate for Payer: Altius Commercial |
$1.13
|
| Rate for Payer: Beech Street Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.14
|
| Rate for Payer: Cigna of WY Commercial |
$1.16
|
| Rate for Payer: Entrust Commercial |
$1.12
|
| Rate for Payer: First Choice Health Commercial |
$1.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.78
|
| Rate for Payer: HealthUtah PPO |
$1.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1.16
|
| Rate for Payer: PacificSource Commercial |
$1.06
|
| Rate for Payer: PHCS PPO |
$1.16
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| Rate for Payer: TriWest Veterans Administration |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Medicare |
$0.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1.12
|
|
|
PEN NEEDLE,DIABETIC DUAL SAFETY 30 GAUGE X 3/16" [94454]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 8470795501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.16
|
| Rate for Payer: Aetna of WY Medicare |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.13
|
| Rate for Payer: Altius Commercial |
$1.13
|
| Rate for Payer: Beech Street Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.14
|
| Rate for Payer: Cigna of WY Commercial |
$1.16
|
| Rate for Payer: Entrust Commercial |
$1.12
|
| Rate for Payer: First Choice Health Commercial |
$1.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.68
|
| Rate for Payer: HealthUtah PPO |
$1.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.16
|
| Rate for Payer: PacificSource Commercial |
$1.06
|
| Rate for Payer: PHCS PPO |
$1.16
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| Rate for Payer: TriWest Veterans Administration |
$0.68
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Medicare |
$0.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1.16
|
| Rate for Payer: Wise Provider Network Commercial |
$1.12
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [5770]
|
Facility
|
IP
|
$185.98
|
|
|
Service Code
|
HCPCS J2545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.54
|
| Rate for Payer: Altius Commercial |
$178.54
|
| Rate for Payer: Beech Street Commercial |
$182.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.69
|
| Rate for Payer: Cash Price |
$130.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.40
|
| Rate for Payer: Cigna of WY Commercial |
$182.26
|
| Rate for Payer: Entrust Commercial |
$176.68
|
| Rate for Payer: First Choice Health Commercial |
$176.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.75
|
| Rate for Payer: HealthUtah PPO |
$185.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.40
|
| Rate for Payer: Multiplan Medicare/VA |
$116.61
|
| Rate for Payer: One Health Plan of WY PPO |
$182.26
|
| Rate for Payer: PacificSource Commercial |
$167.38
|
| Rate for Payer: PHCS PPO |
$182.26
|
| Rate for Payer: Three Rivers PPO |
$139.48
|
| Rate for Payer: TriWest Veterans Administration |
$122.75
|
| Rate for Payer: United Healthcare Commercial |
$161.80
|
| Rate for Payer: United Healthcare Medicare |
$122.75
|
| Rate for Payer: WINHealth Partners Commercial |
$176.68
|
| Rate for Payer: Wise Provider Network Commercial |
$176.68
|
|
|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION [5770]
|
Facility
|
OP
|
$185.98
|
|
|
Service Code
|
HCPCS J2545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.26
|
| Rate for Payer: Aetna of WY Medicare |
$122.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$178.54
|
| Rate for Payer: Altius Commercial |
$178.54
|
| Rate for Payer: Beech Street Commercial |
$182.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.69
|
| Rate for Payer: Cash Price |
$130.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$180.40
|
| Rate for Payer: Cigna of WY Commercial |
$182.26
|
| Rate for Payer: Entrust Commercial |
$176.68
|
| Rate for Payer: First Choice Health Commercial |
$176.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.87
|
| Rate for Payer: HealthUtah PPO |
$185.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.40
|
| Rate for Payer: Multiplan Medicare/VA |
$102.47
|
| Rate for Payer: One Health Plan of WY PPO |
$182.26
|
| Rate for Payer: PacificSource Commercial |
$167.38
|
| Rate for Payer: PHCS PPO |
$182.26
|
| Rate for Payer: Three Rivers PPO |
$139.48
|
| Rate for Payer: TriWest Veterans Administration |
$107.87
|
| Rate for Payer: United Healthcare Commercial |
$161.80
|
| Rate for Payer: United Healthcare Medicare |
$107.87
|
| Rate for Payer: WINHealth Partners Commercial |
$182.26
|
| Rate for Payer: Wise Provider Network Commercial |
$176.68
|
|
|
PERC INSERTION KIT 3.9MM KNOTLESS CORK
|
Facility
|
OP
|
$1,328.60
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.06 |
| Max. Negotiated Rate |
$1,328.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,302.03
|
| Rate for Payer: Aetna of WY Medicare |
$876.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,275.46
|
| Rate for Payer: Altius Commercial |
$1,275.46
|
| Rate for Payer: Beech Street Commercial |
$1,302.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,090.78
|
| Rate for Payer: Cash Price |
$930.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,302.03
|
| Rate for Payer: Entrust Commercial |
$1,262.17
|
| Rate for Payer: First Choice Health Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.59
|
| Rate for Payer: HealthUtah PPO |
$1,328.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.74
|
| Rate for Payer: Multiplan Medicare/VA |
$732.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,302.03
|
| Rate for Payer: PacificSource Commercial |
$1,195.74
|
| Rate for Payer: PHCS PPO |
$1,302.03
|
| Rate for Payer: Three Rivers PPO |
$996.45
|
| Rate for Payer: TriWest Veterans Administration |
$770.59
|
| Rate for Payer: United Healthcare Commercial |
$1,155.88
|
| Rate for Payer: United Healthcare Medicare |
$770.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,302.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1,262.17
|
|
|
PERC INSERTION KIT 3.9MM KNOTLESS CORK
|
Facility
|
IP
|
$1,328.60
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$833.03 |
| Max. Negotiated Rate |
$1,328.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,302.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,275.46
|
| Rate for Payer: Altius Commercial |
$1,275.46
|
| Rate for Payer: Beech Street Commercial |
$1,302.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,090.78
|
| Rate for Payer: Cash Price |
$930.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,288.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,302.03
|
| Rate for Payer: Entrust Commercial |
$1,262.17
|
| Rate for Payer: First Choice Health Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,262.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.88
|
| Rate for Payer: HealthUtah PPO |
$1,328.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,288.74
|
| Rate for Payer: Multiplan Medicare/VA |
$833.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,302.03
|
| Rate for Payer: PacificSource Commercial |
$1,195.74
|
| Rate for Payer: PHCS PPO |
$1,302.03
|
| Rate for Payer: Three Rivers PPO |
$996.45
|
| Rate for Payer: TriWest Veterans Administration |
$876.88
|
| Rate for Payer: United Healthcare Commercial |
$1,155.88
|
| Rate for Payer: United Healthcare Medicare |
$876.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,262.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1,262.17
|
|
|
PERCUTANEOUS INSERT KIT 2.9MM
|
Facility
|
IP
|
$1,102.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$691.27 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,080.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,058.40
|
| Rate for Payer: Altius Commercial |
$1,058.40
|
| Rate for Payer: Beech Street Commercial |
$1,080.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$905.15
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,069.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,080.45
|
| Rate for Payer: Entrust Commercial |
$1,047.38
|
| Rate for Payer: First Choice Health Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$727.65
|
| Rate for Payer: HealthUtah PPO |
$1,102.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,069.42
|
| Rate for Payer: Multiplan Medicare/VA |
$691.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,080.45
|
| Rate for Payer: PacificSource Commercial |
$992.25
|
| Rate for Payer: PHCS PPO |
$1,080.45
|
| Rate for Payer: Three Rivers PPO |
$826.88
|
| Rate for Payer: TriWest Veterans Administration |
$727.65
|
| Rate for Payer: United Healthcare Commercial |
$959.18
|
| Rate for Payer: United Healthcare Medicare |
$727.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,047.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,047.38
|
|
|
PERCUTANEOUS INSERT KIT 2.9MM
|
Facility
|
OP
|
$1,102.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.48 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,080.45
|
| Rate for Payer: Aetna of WY Medicare |
$727.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,058.40
|
| Rate for Payer: Altius Commercial |
$1,058.40
|
| Rate for Payer: Beech Street Commercial |
$1,080.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$905.15
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,069.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,080.45
|
| Rate for Payer: Entrust Commercial |
$1,047.38
|
| Rate for Payer: First Choice Health Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$639.45
|
| Rate for Payer: HealthUtah PPO |
$1,102.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,069.42
|
| Rate for Payer: Multiplan Medicare/VA |
$607.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,080.45
|
| Rate for Payer: PacificSource Commercial |
$992.25
|
| Rate for Payer: PHCS PPO |
$1,080.45
|
| Rate for Payer: Three Rivers PPO |
$826.88
|
| Rate for Payer: TriWest Veterans Administration |
$639.45
|
| Rate for Payer: United Healthcare Commercial |
$959.18
|
| Rate for Payer: United Healthcare Medicare |
$639.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,080.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,047.38
|
|
|
PERCUTANEOUS TESTS W/ALLERGENIC XTR IMMT RXN
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
95004
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$3.52
|
| Rate for Payer: Beech Street Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.52
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$2.99
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.20
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$3.52
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
|
|
PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99391
|
| Hospital Charge Code |
99391
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Beech Street Commercial |
$168.15
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: First Choice Health Commercial |
$159.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$168.15
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: WINHealth Partners Commercial |
$168.15
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
99394
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: WINHealth Partners Commercial |
$196.65
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
99392
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Beech Street Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: First Choice Health Commercial |
$169.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$178.60
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$163.56
|
| Rate for Payer: WINHealth Partners Commercial |
$178.60
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
99395
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
99396
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Beech Street Commercial |
$286.90
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: First Choice Health Commercial |
$271.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$286.90
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: WINHealth Partners Commercial |
$286.90
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
99393
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Beech Street Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: First Choice Health Commercial |
$172.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$182.40
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
|
|
PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
99397
|
| Min. Negotiated Rate |
$261.75 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.02
|
| Rate for Payer: Beech Street Commercial |
$331.55
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$338.53
|
| Rate for Payer: Cigna of WY Commercial |
$342.02
|
| Rate for Payer: First Choice Health Commercial |
$314.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$331.55
|
| Rate for Payer: HealthUtah PPO |
$349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$338.53
|
| Rate for Payer: One Health Plan of WY PPO |
$342.02
|
| Rate for Payer: PacificSource Commercial |
$314.10
|
| Rate for Payer: PHCS PPO |
$331.55
|
| Rate for Payer: Three Rivers PPO |
$261.75
|
| Rate for Payer: United Healthcare Commercial |
$303.63
|
| Rate for Payer: WINHealth Partners Commercial |
$331.55
|
|
