|
PORTER DISP MASKS LARGE
|
Facility
|
OP
|
$6.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.00
|
| Rate for Payer: Aetna of WY Medicare |
$4.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.88
|
| Rate for Payer: Altius Commercial |
$5.88
|
| Rate for Payer: Beech Street Commercial |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.94
|
| Rate for Payer: Cigna of WY Commercial |
$6.00
|
| Rate for Payer: Entrust Commercial |
$5.81
|
| Rate for Payer: First Choice Health Commercial |
$5.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.55
|
| Rate for Payer: HealthUtah PPO |
$6.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.94
|
| Rate for Payer: Multiplan Medicare/VA |
$3.37
|
| Rate for Payer: One Health Plan of WY PPO |
$6.00
|
| Rate for Payer: PacificSource Commercial |
$5.51
|
| Rate for Payer: PHCS PPO |
$6.00
|
| Rate for Payer: Three Rivers PPO |
$4.59
|
| Rate for Payer: TriWest Veterans Administration |
$3.55
|
| Rate for Payer: United Healthcare Commercial |
$5.32
|
| Rate for Payer: United Healthcare Medicare |
$3.55
|
| Rate for Payer: WINHealth Partners Commercial |
$6.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5.81
|
|
|
PORTER DISP MASKS LARGE
|
Facility
|
IP
|
$6.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.88
|
| Rate for Payer: Altius Commercial |
$5.88
|
| Rate for Payer: Beech Street Commercial |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.94
|
| Rate for Payer: Cigna of WY Commercial |
$6.00
|
| Rate for Payer: Entrust Commercial |
$5.81
|
| Rate for Payer: First Choice Health Commercial |
$5.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.04
|
| Rate for Payer: HealthUtah PPO |
$6.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.94
|
| Rate for Payer: Multiplan Medicare/VA |
$3.84
|
| Rate for Payer: One Health Plan of WY PPO |
$6.00
|
| Rate for Payer: PacificSource Commercial |
$5.51
|
| Rate for Payer: PHCS PPO |
$6.00
|
| Rate for Payer: Three Rivers PPO |
$4.59
|
| Rate for Payer: TriWest Veterans Administration |
$4.04
|
| Rate for Payer: United Healthcare Commercial |
$5.32
|
| Rate for Payer: United Healthcare Medicare |
$4.04
|
| Rate for Payer: WINHealth Partners Commercial |
$5.81
|
| Rate for Payer: Wise Provider Network Commercial |
$5.81
|
|
|
PORTER DISP MASKS REGULAR
|
Facility
|
IP
|
$8.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.34
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$5.07
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$5.34
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
| Rate for Payer: WINHealth Partners Commercial |
$7.69
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
PORTER DISP MASKS REGULAR
|
Facility
|
OP
|
$8.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.93
|
| Rate for Payer: Aetna of WY Medicare |
$5.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.77
|
| Rate for Payer: Altius Commercial |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.85
|
| Rate for Payer: Cigna of WY Commercial |
$7.93
|
| Rate for Payer: Entrust Commercial |
$7.69
|
| Rate for Payer: First Choice Health Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.69
|
| Rate for Payer: HealthUtah PPO |
$8.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.85
|
| Rate for Payer: Multiplan Medicare/VA |
$4.46
|
| Rate for Payer: One Health Plan of WY PPO |
$7.93
|
| Rate for Payer: PacificSource Commercial |
$7.28
|
| Rate for Payer: PHCS PPO |
$7.93
|
| Rate for Payer: Three Rivers PPO |
$6.07
|
| Rate for Payer: TriWest Veterans Administration |
$4.69
|
| Rate for Payer: United Healthcare Commercial |
$7.04
|
| Rate for Payer: United Healthcare Medicare |
$4.69
|
| Rate for Payer: WINHealth Partners Commercial |
$7.93
|
| Rate for Payer: Wise Provider Network Commercial |
$7.69
|
|
|
PORTER DISP MASKS SMALL
|
Facility
|
OP
|
$6.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.97
|
| Rate for Payer: Aetna of WY Medicare |
$4.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.85
|
| Rate for Payer: Altius Commercial |
$5.85
|
| Rate for Payer: Beech Street Commercial |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.91
|
| Rate for Payer: Cigna of WY Commercial |
$5.97
|
| Rate for Payer: Entrust Commercial |
$5.79
|
| Rate for Payer: First Choice Health Commercial |
$5.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.91
|
| Rate for Payer: Multiplan Medicare/VA |
$3.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5.97
|
| Rate for Payer: PacificSource Commercial |
$5.48
|
| Rate for Payer: PHCS PPO |
$5.97
|
| Rate for Payer: Three Rivers PPO |
$4.57
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.30
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$5.97
|
| Rate for Payer: Wise Provider Network Commercial |
$5.79
|
|
|
PORTER DISP MASKS SMALL
|
Facility
|
IP
|
$6.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.85
|
| Rate for Payer: Altius Commercial |
$5.85
|
| Rate for Payer: Beech Street Commercial |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.91
|
| Rate for Payer: Cigna of WY Commercial |
$5.97
|
| Rate for Payer: Entrust Commercial |
$5.79
|
| Rate for Payer: First Choice Health Commercial |
$5.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.02
|
| Rate for Payer: HealthUtah PPO |
$6.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.91
|
| Rate for Payer: Multiplan Medicare/VA |
$3.82
|
| Rate for Payer: One Health Plan of WY PPO |
$5.97
|
| Rate for Payer: PacificSource Commercial |
$5.48
|
| Rate for Payer: PHCS PPO |
$5.97
|
| Rate for Payer: Three Rivers PPO |
$4.57
|
| Rate for Payer: TriWest Veterans Administration |
$4.02
|
| Rate for Payer: United Healthcare Commercial |
$5.30
|
| Rate for Payer: United Healthcare Medicare |
$4.02
|
| Rate for Payer: WINHealth Partners Commercial |
$5.79
|
| Rate for Payer: Wise Provider Network Commercial |
$5.79
|
|
|
POSITIONER UPPER EXTREMITY
|
Facility
|
OP
|
$36.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.19 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.92
|
| Rate for Payer: Aetna of WY Medicare |
$24.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.18
|
| Rate for Payer: Altius Commercial |
$35.18
|
| Rate for Payer: Beech Street Commercial |
$35.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.09
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.55
|
| Rate for Payer: Cigna of WY Commercial |
$35.92
|
| Rate for Payer: Entrust Commercial |
$34.82
|
| Rate for Payer: First Choice Health Commercial |
$34.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.26
|
| Rate for Payer: HealthUtah PPO |
$36.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.55
|
| Rate for Payer: Multiplan Medicare/VA |
$20.19
|
| Rate for Payer: One Health Plan of WY PPO |
$35.92
|
| Rate for Payer: PacificSource Commercial |
$32.98
|
| Rate for Payer: PHCS PPO |
$35.92
|
| Rate for Payer: Three Rivers PPO |
$27.49
|
| Rate for Payer: TriWest Veterans Administration |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$31.89
|
| Rate for Payer: United Healthcare Medicare |
$21.26
|
| Rate for Payer: WINHealth Partners Commercial |
$35.92
|
| Rate for Payer: Wise Provider Network Commercial |
$34.82
|
|
|
POSITIONER UPPER EXTREMITY
|
Facility
|
IP
|
$36.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.18
|
| Rate for Payer: Altius Commercial |
$35.18
|
| Rate for Payer: Beech Street Commercial |
$35.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.09
|
| Rate for Payer: Cash Price |
$25.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.55
|
| Rate for Payer: Cigna of WY Commercial |
$35.92
|
| Rate for Payer: Entrust Commercial |
$34.82
|
| Rate for Payer: First Choice Health Commercial |
$34.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.19
|
| Rate for Payer: HealthUtah PPO |
$36.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.55
|
| Rate for Payer: Multiplan Medicare/VA |
$22.98
|
| Rate for Payer: One Health Plan of WY PPO |
$35.92
|
| Rate for Payer: PacificSource Commercial |
$32.98
|
| Rate for Payer: PHCS PPO |
$35.92
|
| Rate for Payer: Three Rivers PPO |
$27.49
|
| Rate for Payer: TriWest Veterans Administration |
$24.19
|
| Rate for Payer: United Healthcare Commercial |
$31.89
|
| Rate for Payer: United Healthcare Medicare |
$24.19
|
| Rate for Payer: WINHealth Partners Commercial |
$34.82
|
| Rate for Payer: Wise Provider Network Commercial |
$34.82
|
|
|
POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$2,161.00
|
|
|
Service Code
|
HCPCS 57250
|
| Hospital Charge Code |
57250
|
| Min. Negotiated Rate |
$1,620.75 |
| Max. Negotiated Rate |
$2,161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,117.78
|
| Rate for Payer: Beech Street Commercial |
$2,052.95
|
| Rate for Payer: Cash Price |
$1,512.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,096.17
|
| Rate for Payer: Cigna of WY Commercial |
$2,117.78
|
| Rate for Payer: First Choice Health Commercial |
$1,944.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,052.95
|
| Rate for Payer: HealthUtah PPO |
$2,161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,096.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,117.78
|
| Rate for Payer: PacificSource Commercial |
$1,944.90
|
| Rate for Payer: PHCS PPO |
$2,052.95
|
| Rate for Payer: Three Rivers PPO |
$1,620.75
|
| Rate for Payer: United Healthcare Commercial |
$1,880.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,836.85
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS 22840 80
|
| Hospital Charge Code |
22840
|
| Min. Negotiated Rate |
$601.05 |
| Max. Negotiated Rate |
$2,524.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,473.52
|
| Rate for Payer: Aetna of WY Medicare |
$707.12
|
| Rate for Payer: Beech Street Commercial |
$2,397.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,448.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,473.52
|
| Rate for Payer: First Choice Health Commercial |
$2,271.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.12
|
| Rate for Payer: HealthUtah PPO |
$2,524.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,448.28
|
| Rate for Payer: Multiplan Medicare/VA |
$601.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,473.52
|
| Rate for Payer: PacificSource Commercial |
$2,271.60
|
| Rate for Payer: PHCS PPO |
$2,397.80
|
| Rate for Payer: Three Rivers PPO |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.12
|
| Rate for Payer: United Healthcare Commercial |
$2,195.88
|
| Rate for Payer: United Healthcare Medicare |
$707.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,145.40
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS 22840
|
| Hospital Charge Code |
22840
|
| Min. Negotiated Rate |
$601.05 |
| Max. Negotiated Rate |
$2,524.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,473.52
|
| Rate for Payer: Aetna of WY Medicare |
$707.12
|
| Rate for Payer: Beech Street Commercial |
$2,397.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,448.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,473.52
|
| Rate for Payer: First Choice Health Commercial |
$2,271.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.12
|
| Rate for Payer: HealthUtah PPO |
$2,524.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,448.28
|
| Rate for Payer: Multiplan Medicare/VA |
$601.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,473.52
|
| Rate for Payer: PacificSource Commercial |
$2,271.60
|
| Rate for Payer: PHCS PPO |
$2,397.80
|
| Rate for Payer: Three Rivers PPO |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.12
|
| Rate for Payer: United Healthcare Commercial |
$2,195.88
|
| Rate for Payer: United Healthcare Medicare |
$707.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,145.40
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS 22840 AS
|
| Hospital Charge Code |
22840
|
| Min. Negotiated Rate |
$601.05 |
| Max. Negotiated Rate |
$2,524.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,473.52
|
| Rate for Payer: Aetna of WY Medicare |
$707.12
|
| Rate for Payer: Beech Street Commercial |
$2,397.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: Cash Price |
$1,766.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,448.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,473.52
|
| Rate for Payer: First Choice Health Commercial |
$2,271.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.12
|
| Rate for Payer: HealthUtah PPO |
$2,524.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,448.28
|
| Rate for Payer: Multiplan Medicare/VA |
$601.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,473.52
|
| Rate for Payer: PacificSource Commercial |
$2,271.60
|
| Rate for Payer: PHCS PPO |
$2,397.80
|
| Rate for Payer: Three Rivers PPO |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.12
|
| Rate for Payer: United Healthcare Commercial |
$2,195.88
|
| Rate for Payer: United Healthcare Medicare |
$707.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,145.40
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,891.00
|
|
|
Service Code
|
HCPCS 22842 AS
|
| Hospital Charge Code |
22842
|
| Min. Negotiated Rate |
$605.73 |
| Max. Negotiated Rate |
$3,891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,813.18
|
| Rate for Payer: Aetna of WY Medicare |
$712.62
|
| Rate for Payer: Beech Street Commercial |
$3,696.45
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,774.27
|
| Rate for Payer: Cigna of WY Commercial |
$3,813.18
|
| Rate for Payer: First Choice Health Commercial |
$3,501.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,696.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.62
|
| Rate for Payer: HealthUtah PPO |
$3,891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,774.27
|
| Rate for Payer: Multiplan Medicare/VA |
$605.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,813.18
|
| Rate for Payer: PacificSource Commercial |
$3,501.90
|
| Rate for Payer: PHCS PPO |
$3,696.45
|
| Rate for Payer: Three Rivers PPO |
$2,918.25
|
| Rate for Payer: TriWest Veterans Administration |
$712.62
|
| Rate for Payer: United Healthcare Commercial |
$3,385.17
|
| Rate for Payer: United Healthcare Medicare |
$712.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.35
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,891.00
|
|
|
Service Code
|
HCPCS 22842
|
| Hospital Charge Code |
22842
|
| Min. Negotiated Rate |
$605.73 |
| Max. Negotiated Rate |
$3,891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,813.18
|
| Rate for Payer: Aetna of WY Medicare |
$712.62
|
| Rate for Payer: Beech Street Commercial |
$3,696.45
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,774.27
|
| Rate for Payer: Cigna of WY Commercial |
$3,813.18
|
| Rate for Payer: First Choice Health Commercial |
$3,501.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,696.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.62
|
| Rate for Payer: HealthUtah PPO |
$3,891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,774.27
|
| Rate for Payer: Multiplan Medicare/VA |
$605.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,813.18
|
| Rate for Payer: PacificSource Commercial |
$3,501.90
|
| Rate for Payer: PHCS PPO |
$3,696.45
|
| Rate for Payer: Three Rivers PPO |
$2,918.25
|
| Rate for Payer: TriWest Veterans Administration |
$712.62
|
| Rate for Payer: United Healthcare Commercial |
$3,385.17
|
| Rate for Payer: United Healthcare Medicare |
$712.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.35
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,891.00
|
|
|
Service Code
|
HCPCS 22842 80
|
| Hospital Charge Code |
22842
|
| Min. Negotiated Rate |
$605.73 |
| Max. Negotiated Rate |
$3,891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,813.18
|
| Rate for Payer: Aetna of WY Medicare |
$712.62
|
| Rate for Payer: Beech Street Commercial |
$3,696.45
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: Cash Price |
$2,723.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,774.27
|
| Rate for Payer: Cigna of WY Commercial |
$3,813.18
|
| Rate for Payer: First Choice Health Commercial |
$3,501.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,696.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.62
|
| Rate for Payer: HealthUtah PPO |
$3,891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,774.27
|
| Rate for Payer: Multiplan Medicare/VA |
$605.73
|
| Rate for Payer: One Health Plan of WY PPO |
$3,813.18
|
| Rate for Payer: PacificSource Commercial |
$3,501.90
|
| Rate for Payer: PHCS PPO |
$3,696.45
|
| Rate for Payer: Three Rivers PPO |
$2,918.25
|
| Rate for Payer: TriWest Veterans Administration |
$712.62
|
| Rate for Payer: United Healthcare Commercial |
$3,385.17
|
| Rate for Payer: United Healthcare Medicare |
$712.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.35
|
|
|
POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
59430
|
| Min. Negotiated Rate |
$143.48 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$168.80
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.80
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$143.48
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.80
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$168.80
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
|
|
POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [10090]
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.89
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.55
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Altius Commercial |
$14.58
|
| Rate for Payer: Beech Street Commercial |
$14.89
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.47
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.89
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: Entrust Commercial |
$14.43
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.01
|
| Rate for Payer: HealthUtah PPO |
$15.19
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.73
|
| Rate for Payer: Multiplan Medicare/VA |
$9.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.51
|
| Rate for Payer: One Health Plan of WY PPO |
$14.89
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: PacificSource Commercial |
$13.67
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: PHCS PPO |
$14.89
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: Three Rivers PPO |
$11.39
|
| Rate for Payer: TriWest Veterans Administration |
$10.03
|
| Rate for Payer: TriWest Veterans Administration |
$10.01
|
| Rate for Payer: United Healthcare Commercial |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$13.22
|
| Rate for Payer: United Healthcare Medicare |
$10.03
|
| Rate for Payer: United Healthcare Medicare |
$10.01
|
| Rate for Payer: WINHealth Partners Commercial |
$14.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
| Rate for Payer: Wise Provider Network Commercial |
$14.43
|
|
|
POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK [10090]
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.89
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.58
|
| Rate for Payer: Altius Commercial |
$14.58
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.45
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$14.89
|
| Rate for Payer: Entrust Commercial |
$14.43
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.79
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: HealthUtah PPO |
$15.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.37
|
| Rate for Payer: Multiplan Medicare/VA |
$8.35
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: One Health Plan of WY PPO |
$14.89
|
| Rate for Payer: PacificSource Commercial |
$13.67
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: PHCS PPO |
$14.89
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: Three Rivers PPO |
$11.39
|
| Rate for Payer: TriWest Veterans Administration |
$8.81
|
| Rate for Payer: TriWest Veterans Administration |
$8.79
|
| Rate for Payer: United Healthcare Commercial |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$13.22
|
| Rate for Payer: United Healthcare Medicare |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$8.79
|
| Rate for Payer: WINHealth Partners Commercial |
$14.86
|
| Rate for Payer: WINHealth Partners Commercial |
$14.89
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
| Rate for Payer: Wise Provider Network Commercial |
$14.43
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [5001]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0990799309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [5001]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0990799309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [5001]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0338066904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV [5001]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0338066904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [28476]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN [28476]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [14206]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
HCPCS J3480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
