|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$5,474.00
|
|
|
Service Code
|
HCPCS 23462
|
| Hospital Charge Code |
23462
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$5,474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,364.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,027.90
|
| Rate for Payer: Beech Street Commercial |
$5,200.30
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,309.78
|
| Rate for Payer: Cigna of WY Commercial |
$5,364.52
|
| Rate for Payer: First Choice Health Commercial |
$4,926.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,200.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,027.90
|
| Rate for Payer: HealthUtah PPO |
$5,474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,309.78
|
| Rate for Payer: Multiplan Medicare/VA |
$873.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,364.52
|
| Rate for Payer: PacificSource Commercial |
$4,926.60
|
| Rate for Payer: PHCS PPO |
$5,200.30
|
| Rate for Payer: Three Rivers PPO |
$4,105.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,027.90
|
| Rate for Payer: United Healthcare Commercial |
$4,762.38
|
| Rate for Payer: United Healthcare Medicare |
$1,027.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,652.90
|
|
|
CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$5,093.00
|
|
|
Service Code
|
HCPCS 23455 AS
|
| Hospital Charge Code |
23455
|
| Min. Negotiated Rate |
$808.42 |
| Max. Negotiated Rate |
$5,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,991.14
|
| Rate for Payer: Aetna of WY Medicare |
$951.08
|
| Rate for Payer: Beech Street Commercial |
$4,838.35
|
| Rate for Payer: Cash Price |
$3,565.10
|
| Rate for Payer: Cash Price |
$3,565.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,940.21
|
| Rate for Payer: Cigna of WY Commercial |
$4,991.14
|
| Rate for Payer: First Choice Health Commercial |
$4,583.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,838.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$951.08
|
| Rate for Payer: HealthUtah PPO |
$5,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,940.21
|
| Rate for Payer: Multiplan Medicare/VA |
$808.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4,991.14
|
| Rate for Payer: PacificSource Commercial |
$4,583.70
|
| Rate for Payer: PHCS PPO |
$4,838.35
|
| Rate for Payer: Three Rivers PPO |
$3,819.75
|
| Rate for Payer: TriWest Veterans Administration |
$951.08
|
| Rate for Payer: United Healthcare Commercial |
$4,430.91
|
| Rate for Payer: United Healthcare Medicare |
$951.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,329.05
|
|
|
CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$5,093.00
|
|
|
Service Code
|
HCPCS 23455
|
| Hospital Charge Code |
23455
|
| Min. Negotiated Rate |
$808.42 |
| Max. Negotiated Rate |
$5,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,991.14
|
| Rate for Payer: Aetna of WY Medicare |
$951.08
|
| Rate for Payer: Beech Street Commercial |
$4,838.35
|
| Rate for Payer: Cash Price |
$3,565.10
|
| Rate for Payer: Cash Price |
$3,565.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,940.21
|
| Rate for Payer: Cigna of WY Commercial |
$4,991.14
|
| Rate for Payer: First Choice Health Commercial |
$4,583.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,838.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$951.08
|
| Rate for Payer: HealthUtah PPO |
$5,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,940.21
|
| Rate for Payer: Multiplan Medicare/VA |
$808.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4,991.14
|
| Rate for Payer: PacificSource Commercial |
$4,583.70
|
| Rate for Payer: PHCS PPO |
$4,838.35
|
| Rate for Payer: Three Rivers PPO |
$3,819.75
|
| Rate for Payer: TriWest Veterans Administration |
$951.08
|
| Rate for Payer: United Healthcare Commercial |
$4,430.91
|
| Rate for Payer: United Healthcare Medicare |
$951.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,329.05
|
|
|
CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 23465
|
| Hospital Charge Code |
23465
|
| Min. Negotiated Rate |
$915.70 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,077.30
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,077.30
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$915.70
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,077.30
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,077.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$5,660.00
|
|
|
Service Code
|
HCPCS 23465 AS
|
| Hospital Charge Code |
23465
|
| Min. Negotiated Rate |
$915.70 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,546.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,077.30
|
| Rate for Payer: Beech Street Commercial |
$5,377.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: Cash Price |
$3,962.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,490.20
|
| Rate for Payer: Cigna of WY Commercial |
$5,546.80
|
| Rate for Payer: First Choice Health Commercial |
$5,094.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,377.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,077.30
|
| Rate for Payer: HealthUtah PPO |
$5,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,490.20
|
| Rate for Payer: Multiplan Medicare/VA |
$915.70
|
| Rate for Payer: One Health Plan of WY PPO |
$5,546.80
|
| Rate for Payer: PacificSource Commercial |
$5,094.00
|
| Rate for Payer: PHCS PPO |
$5,377.00
|
| Rate for Payer: Three Rivers PPO |
$4,245.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,077.30
|
| Rate for Payer: United Healthcare Commercial |
$4,924.20
|
| Rate for Payer: United Healthcare Medicare |
$1,077.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,811.00
|
|
|
CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS
|
Professional
|
Both
|
$5,615.00
|
|
|
Service Code
|
HCPCS 23466
|
| Hospital Charge Code |
23466
|
| Min. Negotiated Rate |
$922.16 |
| Max. Negotiated Rate |
$5,615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,502.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,084.89
|
| Rate for Payer: Beech Street Commercial |
$5,334.25
|
| Rate for Payer: Cash Price |
$3,930.50
|
| Rate for Payer: Cash Price |
$3,930.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,446.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,502.70
|
| Rate for Payer: First Choice Health Commercial |
$5,053.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,334.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.89
|
| Rate for Payer: HealthUtah PPO |
$5,615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,446.55
|
| Rate for Payer: Multiplan Medicare/VA |
$922.16
|
| Rate for Payer: One Health Plan of WY PPO |
$5,502.70
|
| Rate for Payer: PacificSource Commercial |
$5,053.50
|
| Rate for Payer: PHCS PPO |
$5,334.25
|
| Rate for Payer: Three Rivers PPO |
$4,211.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.89
|
| Rate for Payer: United Healthcare Commercial |
$4,885.05
|
| Rate for Payer: United Healthcare Medicare |
$1,084.89
|
| Rate for Payer: WINHealth Partners Commercial |
$4,772.75
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$4,177.00
|
|
|
Service Code
|
HCPCS 27435 AS
|
| Hospital Charge Code |
27435
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$4,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,093.46
|
| Rate for Payer: Aetna of WY Medicare |
$784.66
|
| Rate for Payer: Beech Street Commercial |
$3,968.15
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,051.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,093.46
|
| Rate for Payer: First Choice Health Commercial |
$3,759.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,968.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$784.66
|
| Rate for Payer: HealthUtah PPO |
$4,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,051.69
|
| Rate for Payer: Multiplan Medicare/VA |
$666.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,093.46
|
| Rate for Payer: PacificSource Commercial |
$3,759.30
|
| Rate for Payer: PHCS PPO |
$3,968.15
|
| Rate for Payer: Three Rivers PPO |
$3,132.75
|
| Rate for Payer: TriWest Veterans Administration |
$784.66
|
| Rate for Payer: United Healthcare Commercial |
$3,633.99
|
| Rate for Payer: United Healthcare Medicare |
$784.66
|
| Rate for Payer: WINHealth Partners Commercial |
$3,550.45
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$4,177.00
|
|
|
Service Code
|
HCPCS 27435
|
| Hospital Charge Code |
27435
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$4,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,093.46
|
| Rate for Payer: Aetna of WY Medicare |
$784.66
|
| Rate for Payer: Beech Street Commercial |
$3,968.15
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,051.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,093.46
|
| Rate for Payer: First Choice Health Commercial |
$3,759.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,968.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$784.66
|
| Rate for Payer: HealthUtah PPO |
$4,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,051.69
|
| Rate for Payer: Multiplan Medicare/VA |
$666.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,093.46
|
| Rate for Payer: PacificSource Commercial |
$3,759.30
|
| Rate for Payer: PHCS PPO |
$3,968.15
|
| Rate for Payer: Three Rivers PPO |
$3,132.75
|
| Rate for Payer: TriWest Veterans Administration |
$784.66
|
| Rate for Payer: United Healthcare Commercial |
$3,633.99
|
| Rate for Payer: United Healthcare Medicare |
$784.66
|
| Rate for Payer: WINHealth Partners Commercial |
$3,550.45
|
|
|
CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$4,177.00
|
|
|
Service Code
|
HCPCS 27435 80
|
| Hospital Charge Code |
27435
|
| Min. Negotiated Rate |
$666.96 |
| Max. Negotiated Rate |
$4,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,093.46
|
| Rate for Payer: Aetna of WY Medicare |
$784.66
|
| Rate for Payer: Beech Street Commercial |
$3,968.15
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: Cash Price |
$2,923.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,051.69
|
| Rate for Payer: Cigna of WY Commercial |
$4,093.46
|
| Rate for Payer: First Choice Health Commercial |
$3,759.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,968.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$784.66
|
| Rate for Payer: HealthUtah PPO |
$4,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,051.69
|
| Rate for Payer: Multiplan Medicare/VA |
$666.96
|
| Rate for Payer: One Health Plan of WY PPO |
$4,093.46
|
| Rate for Payer: PacificSource Commercial |
$3,759.30
|
| Rate for Payer: PHCS PPO |
$3,968.15
|
| Rate for Payer: Three Rivers PPO |
$3,132.75
|
| Rate for Payer: TriWest Veterans Administration |
$784.66
|
| Rate for Payer: United Healthcare Commercial |
$3,633.99
|
| Rate for Payer: United Healthcare Medicare |
$784.66
|
| Rate for Payer: WINHealth Partners Commercial |
$3,550.45
|
|
|
CAPSULOTOMY WRIST
|
Professional
|
Both
|
$2,318.00
|
|
|
Service Code
|
HCPCS 25085
|
| Hospital Charge Code |
25085
|
| Min. Negotiated Rate |
$375.76 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,271.64
|
| Rate for Payer: Aetna of WY Medicare |
$442.07
|
| Rate for Payer: Beech Street Commercial |
$2,202.10
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: Cash Price |
$1,622.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,248.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,271.64
|
| Rate for Payer: First Choice Health Commercial |
$2,086.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,202.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.07
|
| Rate for Payer: HealthUtah PPO |
$2,318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,248.46
|
| Rate for Payer: Multiplan Medicare/VA |
$375.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,271.64
|
| Rate for Payer: PacificSource Commercial |
$2,086.20
|
| Rate for Payer: PHCS PPO |
$2,202.10
|
| Rate for Payer: Three Rivers PPO |
$1,738.50
|
| Rate for Payer: TriWest Veterans Administration |
$442.07
|
| Rate for Payer: United Healthcare Commercial |
$2,016.66
|
| Rate for Payer: United Healthcare Medicare |
$442.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,970.30
|
|
|
CARBAMAZEPINE 200 MG TABLET [9411]
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
NDC 6808444411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.21
|
| Rate for Payer: Aetna of WY Medicare |
$1.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.17
|
| Rate for Payer: Altius Commercial |
$2.17
|
| Rate for Payer: Beech Street Commercial |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.19
|
| Rate for Payer: Cigna of WY Commercial |
$2.21
|
| Rate for Payer: Entrust Commercial |
$2.15
|
| Rate for Payer: First Choice Health Commercial |
$2.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.31
|
| Rate for Payer: HealthUtah PPO |
$2.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.19
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2.21
|
| Rate for Payer: PacificSource Commercial |
$2.03
|
| Rate for Payer: PHCS PPO |
$2.21
|
| Rate for Payer: Three Rivers PPO |
$1.70
|
| Rate for Payer: TriWest Veterans Administration |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$1.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2.21
|
| Rate for Payer: Wise Provider Network Commercial |
$2.15
|
|
|
CARBAMAZEPINE 200 MG TABLET [9411]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
NDC 0904617261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.44
|
| Rate for Payer: Altius Commercial |
$3.44
|
| Rate for Payer: Beech Street Commercial |
$3.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.47
|
| Rate for Payer: Cigna of WY Commercial |
$3.51
|
| Rate for Payer: Entrust Commercial |
$3.40
|
| Rate for Payer: First Choice Health Commercial |
$3.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.36
|
| Rate for Payer: HealthUtah PPO |
$3.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.47
|
| Rate for Payer: Multiplan Medicare/VA |
$2.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3.51
|
| Rate for Payer: PacificSource Commercial |
$3.22
|
| Rate for Payer: PHCS PPO |
$3.51
|
| Rate for Payer: Three Rivers PPO |
$2.68
|
| Rate for Payer: TriWest Veterans Administration |
$2.36
|
| Rate for Payer: United Healthcare Commercial |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.36
|
| Rate for Payer: WINHealth Partners Commercial |
$3.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3.40
|
|
|
CARBAMAZEPINE 200 MG TABLET [9411]
|
Facility
|
IP
|
$2.26
|
|
|
Service Code
|
NDC 6808444411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.17
|
| Rate for Payer: Altius Commercial |
$2.17
|
| Rate for Payer: Beech Street Commercial |
$2.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.19
|
| Rate for Payer: Cigna of WY Commercial |
$2.21
|
| Rate for Payer: Entrust Commercial |
$2.15
|
| Rate for Payer: First Choice Health Commercial |
$2.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.49
|
| Rate for Payer: HealthUtah PPO |
$2.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.19
|
| Rate for Payer: Multiplan Medicare/VA |
$1.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2.21
|
| Rate for Payer: PacificSource Commercial |
$2.03
|
| Rate for Payer: PHCS PPO |
$2.21
|
| Rate for Payer: Three Rivers PPO |
$1.70
|
| Rate for Payer: TriWest Veterans Administration |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$1.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2.15
|
| Rate for Payer: Wise Provider Network Commercial |
$2.15
|
|
|
CARBAMAZEPINE 200 MG TABLET [9411]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 0904617261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.51
|
| Rate for Payer: Aetna of WY Medicare |
$2.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.44
|
| Rate for Payer: Altius Commercial |
$3.44
|
| Rate for Payer: Beech Street Commercial |
$3.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.47
|
| Rate for Payer: Cigna of WY Commercial |
$3.51
|
| Rate for Payer: Entrust Commercial |
$3.40
|
| Rate for Payer: First Choice Health Commercial |
$3.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.08
|
| Rate for Payer: HealthUtah PPO |
$3.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.47
|
| Rate for Payer: Multiplan Medicare/VA |
$1.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3.51
|
| Rate for Payer: PacificSource Commercial |
$3.22
|
| Rate for Payer: PHCS PPO |
$3.51
|
| Rate for Payer: Three Rivers PPO |
$2.68
|
| Rate for Payer: TriWest Veterans Administration |
$2.08
|
| Rate for Payer: United Healthcare Commercial |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$2.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3.51
|
| Rate for Payer: Wise Provider Network Commercial |
$3.40
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS [14733]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 0904662735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.33
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.33
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS [14733]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 4612255705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Aetna of WY Medicare |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS [14733]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 0904662735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.49
|
| Rate for Payer: Aetna of WY Medicare |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.48
|
| Rate for Payer: Altius Commercial |
$0.48
|
| Rate for Payer: Beech Street Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.49
|
| Rate for Payer: Entrust Commercial |
$0.48
|
| Rate for Payer: First Choice Health Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.49
|
| Rate for Payer: PacificSource Commercial |
$0.45
|
| Rate for Payer: PHCS PPO |
$0.49
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.49
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
CARBAMIDE PEROXIDE 6.5 % EAR DROPS [14733]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 4612255705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [18223]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
NDC 6068766111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.40
|
| Rate for Payer: Altius Commercial |
$1.40
|
| Rate for Payer: Beech Street Commercial |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.42
|
| Rate for Payer: Cigna of WY Commercial |
$1.43
|
| Rate for Payer: Entrust Commercial |
$1.39
|
| Rate for Payer: First Choice Health Commercial |
$1.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.96
|
| Rate for Payer: HealthUtah PPO |
$1.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.42
|
| Rate for Payer: Multiplan Medicare/VA |
$0.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1.43
|
| Rate for Payer: PacificSource Commercial |
$1.31
|
| Rate for Payer: PHCS PPO |
$1.43
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.27
|
| Rate for Payer: United Healthcare Medicare |
$0.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1.39
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [18223]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 5965145705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [18223]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
NDC 6068766111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.43
|
| Rate for Payer: Aetna of WY Medicare |
$0.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.40
|
| Rate for Payer: Altius Commercial |
$1.40
|
| Rate for Payer: Beech Street Commercial |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.42
|
| Rate for Payer: Cigna of WY Commercial |
$1.43
|
| Rate for Payer: Entrust Commercial |
$1.39
|
| Rate for Payer: First Choice Health Commercial |
$1.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.42
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.43
|
| Rate for Payer: PacificSource Commercial |
$1.31
|
| Rate for Payer: PHCS PPO |
$1.43
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.27
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.43
|
| Rate for Payer: Wise Provider Network Commercial |
$1.39
|
|
|
CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET [18223]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 5965145705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
CARBON MONOXIDE DIFFUSING CAPACITY
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 94720 26
|
| Hospital Charge Code |
94720
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Beech Street Commercial |
$57.95
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: First Choice Health Commercial |
$54.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$57.95
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: WINHealth Partners Commercial |
$57.95
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [29603]
|
Facility
|
OP
|
$18.94
|
|
|
Service Code
|
HCPCS J9045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.02
|
| Rate for Payer: Aetna of WY Medicare |
$12.41
|
| Rate for Payer: Aetna of WY Medicare |
$12.50
|
| Rate for Payer: Aetna of WY Medicare |
$12.11
|
| Rate for Payer: Aetna of WY Medicare |
$12.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.62
|
| Rate for Payer: Altius Commercial |
$18.18
|
| Rate for Payer: Altius Commercial |
$18.05
|
| Rate for Payer: Altius Commercial |
$18.63
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Beech Street Commercial |
$18.42
|
| Rate for Payer: Beech Street Commercial |
$18.56
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Beech Street Commercial |
$19.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.56
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Cigna of WY Commercial |
$18.42
|
| Rate for Payer: Cigna of WY Commercial |
$19.02
|
| Rate for Payer: Entrust Commercial |
$17.86
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: Entrust Commercial |
$18.44
|
| Rate for Payer: Entrust Commercial |
$17.99
|
| Rate for Payer: First Choice Health Commercial |
$17.99
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$18.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.99
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: HealthUtah PPO |
$19.41
|
| Rate for Payer: HealthUtah PPO |
$18.94
|
| Rate for Payer: HealthUtah PPO |
$18.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.44
|
| Rate for Payer: Multiplan Medicare/VA |
$10.11
|
| Rate for Payer: Multiplan Medicare/VA |
$10.69
|
| Rate for Payer: Multiplan Medicare/VA |
$10.36
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: One Health Plan of WY PPO |
$19.02
|
| Rate for Payer: One Health Plan of WY PPO |
$18.56
|
| Rate for Payer: One Health Plan of WY PPO |
$18.42
|
| Rate for Payer: PacificSource Commercial |
$17.47
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PacificSource Commercial |
$16.92
|
| Rate for Payer: PacificSource Commercial |
$17.05
|
| Rate for Payer: PHCS PPO |
$19.02
|
| Rate for Payer: PHCS PPO |
$18.56
|
| Rate for Payer: PHCS PPO |
$18.42
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: Three Rivers PPO |
$14.10
|
| Rate for Payer: Three Rivers PPO |
$14.56
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.90
|
| Rate for Payer: TriWest Veterans Administration |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$10.64
|
| Rate for Payer: TriWest Veterans Administration |
$10.99
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$16.89
|
| Rate for Payer: United Healthcare Medicare |
$10.99
|
| Rate for Payer: United Healthcare Medicare |
$10.64
|
| Rate for Payer: United Healthcare Medicare |
$10.90
|
| Rate for Payer: United Healthcare Medicare |
$11.26
|
| Rate for Payer: WINHealth Partners Commercial |
$19.02
|
| Rate for Payer: WINHealth Partners Commercial |
$18.42
|
| Rate for Payer: WINHealth Partners Commercial |
$17.98
|
| Rate for Payer: WINHealth Partners Commercial |
$18.56
|
| Rate for Payer: Wise Provider Network Commercial |
$17.86
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
| Rate for Payer: Wise Provider Network Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$18.44
|
|
|
CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION [29603]
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
HCPCS J9045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.62
|
| Rate for Payer: Altius Commercial |
$18.05
|
| Rate for Payer: Altius Commercial |
$18.63
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Altius Commercial |
$18.18
|
| Rate for Payer: Beech Street Commercial |
$19.02
|
| Rate for Payer: Beech Street Commercial |
$18.56
|
| Rate for Payer: Beech Street Commercial |
$18.42
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.83
|
| Rate for Payer: Cigna of WY Commercial |
$19.02
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Cigna of WY Commercial |
$18.56
|
| Rate for Payer: Cigna of WY Commercial |
$18.42
|
| Rate for Payer: Entrust Commercial |
$17.99
|
| Rate for Payer: Entrust Commercial |
$18.44
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: Entrust Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$18.44
|
| Rate for Payer: First Choice Health Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.81
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: HealthUtah PPO |
$18.80
|
| Rate for Payer: HealthUtah PPO |
$19.41
|
| Rate for Payer: HealthUtah PPO |
$18.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.51
|
| Rate for Payer: Multiplan Medicare/VA |
$11.88
|
| Rate for Payer: Multiplan Medicare/VA |
$12.17
|
| Rate for Payer: Multiplan Medicare/VA |
$11.79
|
| Rate for Payer: One Health Plan of WY PPO |
$18.56
|
| Rate for Payer: One Health Plan of WY PPO |
$18.42
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: One Health Plan of WY PPO |
$19.02
|
| Rate for Payer: PacificSource Commercial |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PacificSource Commercial |
$16.92
|
| Rate for Payer: PacificSource Commercial |
$17.47
|
| Rate for Payer: PHCS PPO |
$19.02
|
| Rate for Payer: PHCS PPO |
$18.56
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: PHCS PPO |
$18.42
|
| Rate for Payer: Three Rivers PPO |
$14.10
|
| Rate for Payer: Three Rivers PPO |
$14.56
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$12.50
|
| Rate for Payer: TriWest Veterans Administration |
$12.11
|
| Rate for Payer: TriWest Veterans Administration |
$12.41
|
| Rate for Payer: TriWest Veterans Administration |
$12.81
|
| Rate for Payer: United Healthcare Commercial |
$16.89
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Medicare |
$12.11
|
| Rate for Payer: United Healthcare Medicare |
$12.81
|
| Rate for Payer: United Healthcare Medicare |
$12.50
|
| Rate for Payer: United Healthcare Medicare |
$12.41
|
| Rate for Payer: WINHealth Partners Commercial |
$17.86
|
| Rate for Payer: WINHealth Partners Commercial |
$17.43
|
| Rate for Payer: WINHealth Partners Commercial |
$18.44
|
| Rate for Payer: WINHealth Partners Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$17.86
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
| Rate for Payer: Wise Provider Network Commercial |
$18.44
|
|
