|
PILLOW HEAD POSITIONER PURPLE
|
Facility
|
OP
|
$15.26
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.65
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.85
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$8.41
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$8.85
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$8.85
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
|
PILLOW PRONEVIEW MEDIUM INSERT
|
Facility
|
IP
|
$70.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.01
|
| Rate for Payer: Altius Commercial |
$68.01
|
| Rate for Payer: Beech Street Commercial |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.16
|
| Rate for Payer: Cash Price |
$49.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.71
|
| Rate for Payer: Cigna of WY Commercial |
$69.42
|
| Rate for Payer: Entrust Commercial |
$67.30
|
| Rate for Payer: First Choice Health Commercial |
$67.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.75
|
| Rate for Payer: HealthUtah PPO |
$70.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.71
|
| Rate for Payer: Multiplan Medicare/VA |
$44.42
|
| Rate for Payer: One Health Plan of WY PPO |
$69.42
|
| Rate for Payer: PacificSource Commercial |
$63.76
|
| Rate for Payer: PHCS PPO |
$69.42
|
| Rate for Payer: Three Rivers PPO |
$53.13
|
| Rate for Payer: TriWest Veterans Administration |
$46.75
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
| Rate for Payer: United Healthcare Medicare |
$46.75
|
| Rate for Payer: WINHealth Partners Commercial |
$67.30
|
| Rate for Payer: Wise Provider Network Commercial |
$67.30
|
|
|
PILLOW PRONEVIEW MEDIUM INSERT
|
Facility
|
OP
|
$70.84
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.42
|
| Rate for Payer: Aetna of WY Medicare |
$46.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.01
|
| Rate for Payer: Altius Commercial |
$68.01
|
| Rate for Payer: Beech Street Commercial |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.16
|
| Rate for Payer: Cash Price |
$49.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.71
|
| Rate for Payer: Cigna of WY Commercial |
$69.42
|
| Rate for Payer: Entrust Commercial |
$67.30
|
| Rate for Payer: First Choice Health Commercial |
$67.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.09
|
| Rate for Payer: HealthUtah PPO |
$70.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.71
|
| Rate for Payer: Multiplan Medicare/VA |
$39.03
|
| Rate for Payer: One Health Plan of WY PPO |
$69.42
|
| Rate for Payer: PacificSource Commercial |
$63.76
|
| Rate for Payer: PHCS PPO |
$69.42
|
| Rate for Payer: Three Rivers PPO |
$53.13
|
| Rate for Payer: TriWest Veterans Administration |
$41.09
|
| Rate for Payer: United Healthcare Commercial |
$61.63
|
| Rate for Payer: United Healthcare Medicare |
$41.09
|
| Rate for Payer: WINHealth Partners Commercial |
$69.42
|
| Rate for Payer: Wise Provider Network Commercial |
$67.30
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 3334205507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.72
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 6586251330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.69
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 3334205510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.69
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 3334205510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.72
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 6586251330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.72
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIOGLITAZONE 30 MG TABLET [18151]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 3334205507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.70
|
| Rate for Payer: Altius Commercial |
$0.70
|
| Rate for Payer: Beech Street Commercial |
$0.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.71
|
| Rate for Payer: Cigna of WY Commercial |
$0.72
|
| Rate for Payer: Entrust Commercial |
$0.69
|
| Rate for Payer: First Choice Health Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.72
|
| Rate for Payer: PacificSource Commercial |
$0.66
|
| Rate for Payer: PHCS PPO |
$0.72
|
| Rate for Payer: Three Rivers PPO |
$0.55
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.69
|
| Rate for Payer: Wise Provider Network Commercial |
$0.69
|
|
|
PIPELLE ENDOMETRIAL 8200
|
Facility
|
IP
|
$17.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.69
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
PIPELLE ENDOMETRIAL 8200
|
Facility
|
OP
|
$17.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Medicare |
$11.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.19
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.68
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.19
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$10.19
|
| Rate for Payer: WINHealth Partners Commercial |
$17.22
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [11522]
|
Facility
|
IP
|
$28.12
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Altius Commercial |
$27.00
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Beech Street Commercial |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Cigna of WY Commercial |
$27.56
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: Entrust Commercial |
$26.71
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: First Choice Health Commercial |
$26.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$28.12
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.28
|
| Rate for Payer: Multiplan Medicare/VA |
$21.47
|
| Rate for Payer: Multiplan Medicare/VA |
$17.63
|
| Rate for Payer: Multiplan Medicare/VA |
$21.16
|
| Rate for Payer: One Health Plan of WY PPO |
$27.56
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PacificSource Commercial |
$25.31
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$27.56
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$21.09
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$22.28
|
| Rate for Payer: TriWest Veterans Administration |
$18.56
|
| Rate for Payer: TriWest Veterans Administration |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
| Rate for Payer: United Healthcare Medicare |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$22.28
|
| Rate for Payer: WINHealth Partners Commercial |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$26.71
|
| Rate for Payer: WINHealth Partners Commercial |
$32.54
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
| Rate for Payer: Wise Provider Network Commercial |
$26.71
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [11522]
|
Facility
|
OP
|
$33.75
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Aetna of WY Medicare |
$22.28
|
| Rate for Payer: Aetna of WY Medicare |
$22.60
|
| Rate for Payer: Aetna of WY Medicare |
$18.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Altius Commercial |
$27.00
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Beech Street Commercial |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.28
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Cigna of WY Commercial |
$27.56
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: Entrust Commercial |
$26.71
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$26.71
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.86
|
| Rate for Payer: HealthUtah PPO |
$28.12
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Multiplan Medicare/VA |
$15.49
|
| Rate for Payer: Multiplan Medicare/VA |
$18.60
|
| Rate for Payer: Multiplan Medicare/VA |
$18.87
|
| Rate for Payer: One Health Plan of WY PPO |
$27.56
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PacificSource Commercial |
$25.31
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: PHCS PPO |
$27.56
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: Three Rivers PPO |
$21.09
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$19.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.58
|
| Rate for Payer: TriWest Veterans Administration |
$16.31
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Medicare |
$19.86
|
| Rate for Payer: United Healthcare Medicare |
$16.31
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
| Rate for Payer: WINHealth Partners Commercial |
$33.56
|
| Rate for Payer: WINHealth Partners Commercial |
$27.56
|
| Rate for Payer: WINHealth Partners Commercial |
$33.08
|
| Rate for Payer: Wise Provider Network Commercial |
$26.71
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [12119]
|
Facility
|
IP
|
$51.78
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.24
|
| Rate for Payer: Altius Commercial |
$36.24
|
| Rate for Payer: Altius Commercial |
$49.71
|
| Rate for Payer: Beech Street Commercial |
$50.74
|
| Rate for Payer: Beech Street Commercial |
$37.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.51
|
| Rate for Payer: Cash Price |
$36.25
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.23
|
| Rate for Payer: Cigna of WY Commercial |
$50.74
|
| Rate for Payer: Cigna of WY Commercial |
$37.00
|
| Rate for Payer: Entrust Commercial |
$35.86
|
| Rate for Payer: Entrust Commercial |
$49.19
|
| Rate for Payer: First Choice Health Commercial |
$35.86
|
| Rate for Payer: First Choice Health Commercial |
$49.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.92
|
| Rate for Payer: HealthUtah PPO |
$51.78
|
| Rate for Payer: HealthUtah PPO |
$37.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.23
|
| Rate for Payer: Multiplan Medicare/VA |
$32.47
|
| Rate for Payer: Multiplan Medicare/VA |
$23.67
|
| Rate for Payer: One Health Plan of WY PPO |
$50.74
|
| Rate for Payer: One Health Plan of WY PPO |
$37.00
|
| Rate for Payer: PacificSource Commercial |
$46.60
|
| Rate for Payer: PacificSource Commercial |
$33.98
|
| Rate for Payer: PHCS PPO |
$37.00
|
| Rate for Payer: PHCS PPO |
$50.74
|
| Rate for Payer: Three Rivers PPO |
$28.31
|
| Rate for Payer: Three Rivers PPO |
$38.84
|
| Rate for Payer: TriWest Veterans Administration |
$34.17
|
| Rate for Payer: TriWest Veterans Administration |
$24.92
|
| Rate for Payer: United Healthcare Commercial |
$32.84
|
| Rate for Payer: United Healthcare Commercial |
$45.05
|
| Rate for Payer: United Healthcare Medicare |
$34.17
|
| Rate for Payer: United Healthcare Medicare |
$24.92
|
| Rate for Payer: WINHealth Partners Commercial |
$35.86
|
| Rate for Payer: WINHealth Partners Commercial |
$49.19
|
| Rate for Payer: Wise Provider Network Commercial |
$35.86
|
| Rate for Payer: Wise Provider Network Commercial |
$49.19
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION [12119]
|
Facility
|
OP
|
$51.78
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$51.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.00
|
| Rate for Payer: Aetna of WY Medicare |
$34.17
|
| Rate for Payer: Aetna of WY Medicare |
$24.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.71
|
| Rate for Payer: Altius Commercial |
$49.71
|
| Rate for Payer: Altius Commercial |
$36.24
|
| Rate for Payer: Beech Street Commercial |
$37.00
|
| Rate for Payer: Beech Street Commercial |
$50.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.99
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$36.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.62
|
| Rate for Payer: Cigna of WY Commercial |
$37.00
|
| Rate for Payer: Cigna of WY Commercial |
$50.74
|
| Rate for Payer: Entrust Commercial |
$49.19
|
| Rate for Payer: Entrust Commercial |
$35.86
|
| Rate for Payer: First Choice Health Commercial |
$35.86
|
| Rate for Payer: First Choice Health Commercial |
$49.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.90
|
| Rate for Payer: HealthUtah PPO |
$37.75
|
| Rate for Payer: HealthUtah PPO |
$51.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.23
|
| Rate for Payer: Multiplan Medicare/VA |
$28.53
|
| Rate for Payer: Multiplan Medicare/VA |
$20.80
|
| Rate for Payer: One Health Plan of WY PPO |
$37.00
|
| Rate for Payer: One Health Plan of WY PPO |
$50.74
|
| Rate for Payer: PacificSource Commercial |
$46.60
|
| Rate for Payer: PacificSource Commercial |
$33.98
|
| Rate for Payer: PHCS PPO |
$37.00
|
| Rate for Payer: PHCS PPO |
$50.74
|
| Rate for Payer: Three Rivers PPO |
$28.31
|
| Rate for Payer: Three Rivers PPO |
$38.84
|
| Rate for Payer: TriWest Veterans Administration |
$30.03
|
| Rate for Payer: TriWest Veterans Administration |
$21.90
|
| Rate for Payer: United Healthcare Commercial |
$32.84
|
| Rate for Payer: United Healthcare Commercial |
$45.05
|
| Rate for Payer: United Healthcare Medicare |
$30.03
|
| Rate for Payer: United Healthcare Medicare |
$21.90
|
| Rate for Payer: WINHealth Partners Commercial |
$37.00
|
| Rate for Payer: WINHealth Partners Commercial |
$50.74
|
| Rate for Payer: Wise Provider Network Commercial |
$35.86
|
| Rate for Payer: Wise Provider Network Commercial |
$49.19
|
|
|
PIVOT NANO PASS CRESENT
|
Facility
|
OP
|
$910.35
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.14
|
| Rate for Payer: Aetna of WY Medicare |
$600.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$873.94
|
| Rate for Payer: Altius Commercial |
$873.94
|
| Rate for Payer: Beech Street Commercial |
$892.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$747.40
|
| Rate for Payer: Cash Price |
$637.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.04
|
| Rate for Payer: Cigna of WY Commercial |
$892.14
|
| Rate for Payer: Entrust Commercial |
$864.83
|
| Rate for Payer: First Choice Health Commercial |
$864.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$910.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.04
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$892.14
|
| Rate for Payer: PacificSource Commercial |
$819.32
|
| Rate for Payer: PHCS PPO |
$892.14
|
| Rate for Payer: Three Rivers PPO |
$682.76
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$792.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$892.14
|
| Rate for Payer: Wise Provider Network Commercial |
$864.83
|
|
|
PIVOT NANO PASS CRESENT
|
Facility
|
IP
|
$910.35
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.79 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$873.94
|
| Rate for Payer: Altius Commercial |
$873.94
|
| Rate for Payer: Beech Street Commercial |
$892.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$747.40
|
| Rate for Payer: Cash Price |
$637.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.04
|
| Rate for Payer: Cigna of WY Commercial |
$892.14
|
| Rate for Payer: Entrust Commercial |
$864.83
|
| Rate for Payer: First Choice Health Commercial |
$864.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$600.83
|
| Rate for Payer: HealthUtah PPO |
$910.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.04
|
| Rate for Payer: Multiplan Medicare/VA |
$570.79
|
| Rate for Payer: One Health Plan of WY PPO |
$892.14
|
| Rate for Payer: PacificSource Commercial |
$819.32
|
| Rate for Payer: PHCS PPO |
$892.14
|
| Rate for Payer: Three Rivers PPO |
$682.76
|
| Rate for Payer: TriWest Veterans Administration |
$600.83
|
| Rate for Payer: United Healthcare Commercial |
$792.00
|
| Rate for Payer: United Healthcare Medicare |
$600.83
|
| Rate for Payer: WINHealth Partners Commercial |
$864.83
|
| Rate for Payer: Wise Provider Network Commercial |
$864.83
|
|
|
PLACEMENT NEEDLE INTRAOSSEOUS INFUSION
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
36680
|
| Min. Negotiated Rate |
$47.67 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$56.08
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.08
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$47.67
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.08
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$56.08
|
| Rate for Payer: WINHealth Partners Commercial |
$263.50
|
|
|
PLASMABUTTON 12-30° WA22657S
|
Facility
|
OP
|
$1,605.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.49 |
| Max. Negotiated Rate |
$1,605.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,573.14
|
| Rate for Payer: Aetna of WY Medicare |
$1,059.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,541.03
|
| Rate for Payer: Altius Commercial |
$1,541.03
|
| Rate for Payer: Beech Street Commercial |
$1,573.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,317.90
|
| Rate for Payer: Cash Price |
$1,123.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,557.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,573.14
|
| Rate for Payer: Entrust Commercial |
$1,524.98
|
| Rate for Payer: First Choice Health Commercial |
$1,524.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,524.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$931.04
|
| Rate for Payer: HealthUtah PPO |
$1,605.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,557.08
|
| Rate for Payer: Multiplan Medicare/VA |
$884.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,573.14
|
| Rate for Payer: PacificSource Commercial |
$1,444.72
|
| Rate for Payer: PHCS PPO |
$1,573.14
|
| Rate for Payer: Three Rivers PPO |
$1,203.93
|
| Rate for Payer: TriWest Veterans Administration |
$931.04
|
| Rate for Payer: United Healthcare Commercial |
$1,396.56
|
| Rate for Payer: United Healthcare Medicare |
$931.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,573.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,524.98
|
|
|
PLASMABUTTON 12-30° WA22657S
|
Facility
|
IP
|
$1,605.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.49 |
| Max. Negotiated Rate |
$1,605.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,573.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,541.03
|
| Rate for Payer: Altius Commercial |
$1,541.03
|
| Rate for Payer: Beech Street Commercial |
$1,573.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,317.90
|
| Rate for Payer: Cash Price |
$1,123.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,557.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,573.14
|
| Rate for Payer: Entrust Commercial |
$1,524.98
|
| Rate for Payer: First Choice Health Commercial |
$1,524.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,524.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,059.46
|
| Rate for Payer: HealthUtah PPO |
$1,605.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,557.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1,006.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,573.14
|
| Rate for Payer: PacificSource Commercial |
$1,444.72
|
| Rate for Payer: PHCS PPO |
$1,573.14
|
| Rate for Payer: Three Rivers PPO |
$1,203.93
|
| Rate for Payer: TriWest Veterans Administration |
$1,059.46
|
| Rate for Payer: United Healthcare Commercial |
$1,396.56
|
| Rate for Payer: United Healthcare Medicare |
$1,059.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,524.98
|
| Rate for Payer: Wise Provider Network Commercial |
$1,524.98
|
|
|
PLASMALOOP LG LOOP 30 WA22607S
|
Facility
|
IP
|
$1,528.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$958.56 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,498.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.65
|
| Rate for Payer: Altius Commercial |
$1,467.65
|
| Rate for Payer: Beech Street Commercial |
$1,498.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,255.14
|
| Rate for Payer: Cash Price |
$1,070.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.94
|
| Rate for Payer: Cigna of WY Commercial |
$1,498.22
|
| Rate for Payer: Entrust Commercial |
$1,452.36
|
| Rate for Payer: First Choice Health Commercial |
$1,452.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,452.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.01
|
| Rate for Payer: HealthUtah PPO |
$1,528.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.94
|
| Rate for Payer: Multiplan Medicare/VA |
$958.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,498.22
|
| Rate for Payer: PacificSource Commercial |
$1,375.92
|
| Rate for Payer: PHCS PPO |
$1,498.22
|
| Rate for Payer: Three Rivers PPO |
$1,146.60
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.01
|
| Rate for Payer: United Healthcare Commercial |
$1,330.06
|
| Rate for Payer: United Healthcare Medicare |
$1,009.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,452.36
|
| Rate for Payer: Wise Provider Network Commercial |
$1,452.36
|
|
|
PLASMALOOP LG LOOP 30 WA22607S
|
Facility
|
OP
|
$1,528.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.37 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,498.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,009.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.65
|
| Rate for Payer: Altius Commercial |
$1,467.65
|
| Rate for Payer: Beech Street Commercial |
$1,498.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,255.14
|
| Rate for Payer: Cash Price |
$1,070.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.94
|
| Rate for Payer: Cigna of WY Commercial |
$1,498.22
|
| Rate for Payer: Entrust Commercial |
$1,452.36
|
| Rate for Payer: First Choice Health Commercial |
$1,452.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,452.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.70
|
| Rate for Payer: HealthUtah PPO |
$1,528.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.94
|
| Rate for Payer: Multiplan Medicare/VA |
$842.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,498.22
|
| Rate for Payer: PacificSource Commercial |
$1,375.92
|
| Rate for Payer: PHCS PPO |
$1,498.22
|
| Rate for Payer: Three Rivers PPO |
$1,146.60
|
| Rate for Payer: TriWest Veterans Administration |
$886.70
|
| Rate for Payer: United Healthcare Commercial |
$1,330.06
|
| Rate for Payer: United Healthcare Medicare |
$886.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,498.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1,452.36
|
|
|
PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 94726 26
|
| Hospital Charge Code |
94726
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
|
|
PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
94726
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Aetna of WY Medicare |
$54.75
|
| Rate for Payer: Beech Street Commercial |
$38.95
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: First Choice Health Commercial |
$36.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.75
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: Multiplan Medicare/VA |
$46.54
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$38.95
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$54.75
|
| Rate for Payer: WINHealth Partners Commercial |
$38.95
|
|
|
PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 48140 80
|
| Hospital Charge Code |
48140
|
| Min. Negotiated Rate |
$1,260.07 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,151.68
|
| Rate for Payer: Aetna of WY Medicare |
$1,482.43
|
| Rate for Payer: Beech Street Commercial |
$3,055.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: Cash Price |
$2,251.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,119.52
|
| Rate for Payer: Cigna of WY Commercial |
$3,151.68
|
| Rate for Payer: First Choice Health Commercial |
$2,894.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,055.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,482.43
|
| Rate for Payer: HealthUtah PPO |
$3,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,119.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,260.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,151.68
|
| Rate for Payer: PacificSource Commercial |
$2,894.40
|
| Rate for Payer: PHCS PPO |
$3,055.20
|
| Rate for Payer: Three Rivers PPO |
$2,412.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,482.43
|
| Rate for Payer: United Healthcare Commercial |
$2,797.92
|
| Rate for Payer: United Healthcare Medicare |
$1,482.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,733.60
|
|
