|
PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX
|
Professional
|
Both
|
$3,938.00
|
|
|
Service Code
|
HCPCS 24538 80
|
| Hospital Charge Code |
24538
|
| Min. Negotiated Rate |
$654.70 |
| Max. Negotiated Rate |
$3,938.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,859.24
|
| Rate for Payer: Aetna of WY Medicare |
$770.23
|
| Rate for Payer: Beech Street Commercial |
$3,741.10
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: Cash Price |
$2,756.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,819.86
|
| Rate for Payer: Cigna of WY Commercial |
$3,859.24
|
| Rate for Payer: First Choice Health Commercial |
$3,544.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,741.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.23
|
| Rate for Payer: HealthUtah PPO |
$3,938.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,819.86
|
| Rate for Payer: Multiplan Medicare/VA |
$654.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,859.24
|
| Rate for Payer: PacificSource Commercial |
$3,544.20
|
| Rate for Payer: PHCS PPO |
$3,741.10
|
| Rate for Payer: Three Rivers PPO |
$2,953.50
|
| Rate for Payer: TriWest Veterans Administration |
$770.23
|
| Rate for Payer: United Healthcare Commercial |
$3,426.06
|
| Rate for Payer: United Healthcare Medicare |
$770.23
|
| Rate for Payer: WINHealth Partners Commercial |
$3,347.30
|
|
|
PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$6,986.00
|
|
|
Service Code
|
HCPCS 28122 AS
|
| Hospital Charge Code |
28122
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$6,986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,846.28
|
| Rate for Payer: Aetna of WY Medicare |
$429.26
|
| Rate for Payer: Beech Street Commercial |
$6,636.70
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,776.42
|
| Rate for Payer: Cigna of WY Commercial |
$6,846.28
|
| Rate for Payer: First Choice Health Commercial |
$6,287.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,636.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.26
|
| Rate for Payer: HealthUtah PPO |
$6,986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,776.42
|
| Rate for Payer: Multiplan Medicare/VA |
$364.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6,846.28
|
| Rate for Payer: PacificSource Commercial |
$6,287.40
|
| Rate for Payer: PHCS PPO |
$6,636.70
|
| Rate for Payer: Three Rivers PPO |
$5,239.50
|
| Rate for Payer: TriWest Veterans Administration |
$429.26
|
| Rate for Payer: United Healthcare Commercial |
$6,077.82
|
| Rate for Payer: United Healthcare Medicare |
$429.26
|
| Rate for Payer: WINHealth Partners Commercial |
$5,938.10
|
|
|
PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$6,986.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
28122
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$6,986.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,846.28
|
| Rate for Payer: Aetna of WY Medicare |
$429.26
|
| Rate for Payer: Beech Street Commercial |
$6,636.70
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: Cash Price |
$4,890.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,776.42
|
| Rate for Payer: Cigna of WY Commercial |
$6,846.28
|
| Rate for Payer: First Choice Health Commercial |
$6,287.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,636.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.26
|
| Rate for Payer: HealthUtah PPO |
$6,986.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,776.42
|
| Rate for Payer: Multiplan Medicare/VA |
$364.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6,846.28
|
| Rate for Payer: PacificSource Commercial |
$6,287.40
|
| Rate for Payer: PHCS PPO |
$6,636.70
|
| Rate for Payer: Three Rivers PPO |
$5,239.50
|
| Rate for Payer: TriWest Veterans Administration |
$429.26
|
| Rate for Payer: United Healthcare Commercial |
$6,077.82
|
| Rate for Payer: United Healthcare Medicare |
$429.26
|
| Rate for Payer: WINHealth Partners Commercial |
$5,938.10
|
|
|
PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$4,287.00
|
|
|
Service Code
|
HCPCS 27360 AS
|
| Hospital Charge Code |
27360
|
| Min. Negotiated Rate |
$745.13 |
| Max. Negotiated Rate |
$4,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,201.26
|
| Rate for Payer: Aetna of WY Medicare |
$876.62
|
| Rate for Payer: Beech Street Commercial |
$4,072.65
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,158.39
|
| Rate for Payer: Cigna of WY Commercial |
$4,201.26
|
| Rate for Payer: First Choice Health Commercial |
$3,858.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,072.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.62
|
| Rate for Payer: HealthUtah PPO |
$4,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,158.39
|
| Rate for Payer: Multiplan Medicare/VA |
$745.13
|
| Rate for Payer: One Health Plan of WY PPO |
$4,201.26
|
| Rate for Payer: PacificSource Commercial |
$3,858.30
|
| Rate for Payer: PHCS PPO |
$4,072.65
|
| Rate for Payer: Three Rivers PPO |
$3,215.25
|
| Rate for Payer: TriWest Veterans Administration |
$876.62
|
| Rate for Payer: United Healthcare Commercial |
$3,729.69
|
| Rate for Payer: United Healthcare Medicare |
$876.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,643.95
|
|
|
PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$4,287.00
|
|
|
Service Code
|
HCPCS 27360
|
| Hospital Charge Code |
27360
|
| Min. Negotiated Rate |
$745.13 |
| Max. Negotiated Rate |
$4,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,201.26
|
| Rate for Payer: Aetna of WY Medicare |
$876.62
|
| Rate for Payer: Beech Street Commercial |
$4,072.65
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,158.39
|
| Rate for Payer: Cigna of WY Commercial |
$4,201.26
|
| Rate for Payer: First Choice Health Commercial |
$3,858.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,072.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.62
|
| Rate for Payer: HealthUtah PPO |
$4,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,158.39
|
| Rate for Payer: Multiplan Medicare/VA |
$745.13
|
| Rate for Payer: One Health Plan of WY PPO |
$4,201.26
|
| Rate for Payer: PacificSource Commercial |
$3,858.30
|
| Rate for Payer: PHCS PPO |
$4,072.65
|
| Rate for Payer: Three Rivers PPO |
$3,215.25
|
| Rate for Payer: TriWest Veterans Administration |
$876.62
|
| Rate for Payer: United Healthcare Commercial |
$3,729.69
|
| Rate for Payer: United Healthcare Medicare |
$876.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,643.95
|
|
|
PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,641.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
60210
|
| Min. Negotiated Rate |
$577.11 |
| Max. Negotiated Rate |
$3,641.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,568.18
|
| Rate for Payer: Aetna of WY Medicare |
$678.95
|
| Rate for Payer: Beech Street Commercial |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,531.77
|
| Rate for Payer: Cigna of WY Commercial |
$3,568.18
|
| Rate for Payer: First Choice Health Commercial |
$3,276.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,458.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.95
|
| Rate for Payer: HealthUtah PPO |
$3,641.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,531.77
|
| Rate for Payer: Multiplan Medicare/VA |
$577.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,568.18
|
| Rate for Payer: PacificSource Commercial |
$3,276.90
|
| Rate for Payer: PHCS PPO |
$3,458.95
|
| Rate for Payer: Three Rivers PPO |
$2,730.75
|
| Rate for Payer: TriWest Veterans Administration |
$678.95
|
| Rate for Payer: United Healthcare Commercial |
$3,167.67
|
| Rate for Payer: United Healthcare Medicare |
$678.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,094.85
|
|
|
PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,641.00
|
|
|
Service Code
|
HCPCS 60210 80
|
| Hospital Charge Code |
60210
|
| Min. Negotiated Rate |
$577.11 |
| Max. Negotiated Rate |
$3,641.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,568.18
|
| Rate for Payer: Aetna of WY Medicare |
$678.95
|
| Rate for Payer: Beech Street Commercial |
$3,458.95
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: Cash Price |
$2,548.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,531.77
|
| Rate for Payer: Cigna of WY Commercial |
$3,568.18
|
| Rate for Payer: First Choice Health Commercial |
$3,276.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,458.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.95
|
| Rate for Payer: HealthUtah PPO |
$3,641.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,531.77
|
| Rate for Payer: Multiplan Medicare/VA |
$577.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3,568.18
|
| Rate for Payer: PacificSource Commercial |
$3,276.90
|
| Rate for Payer: PHCS PPO |
$3,458.95
|
| Rate for Payer: Three Rivers PPO |
$2,730.75
|
| Rate for Payer: TriWest Veterans Administration |
$678.95
|
| Rate for Payer: United Healthcare Commercial |
$3,167.67
|
| Rate for Payer: United Healthcare Medicare |
$678.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,094.85
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET [15943]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0904699061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Aetna of WY Medicare |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET [15943]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0904699061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90791
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$687.96
|
| Rate for Payer: Aetna of WY Medicare |
$144.20
|
| Rate for Payer: Beech Street Commercial |
$666.90
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$680.94
|
| Rate for Payer: Cigna of WY Commercial |
$687.96
|
| Rate for Payer: First Choice Health Commercial |
$631.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.20
|
| Rate for Payer: HealthUtah PPO |
$702.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$680.94
|
| Rate for Payer: Multiplan Medicare/VA |
$122.57
|
| Rate for Payer: One Health Plan of WY PPO |
$687.96
|
| Rate for Payer: PacificSource Commercial |
$631.80
|
| Rate for Payer: PHCS PPO |
$666.90
|
| Rate for Payer: Three Rivers PPO |
$526.50
|
| Rate for Payer: TriWest Veterans Administration |
$144.20
|
| Rate for Payer: United Healthcare Commercial |
$610.74
|
| Rate for Payer: United Healthcare Medicare |
$144.20
|
| Rate for Payer: WINHealth Partners Commercial |
$666.90
|
|
|
PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90840
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$275.38
|
| Rate for Payer: Aetna of WY Medicare |
$62.84
|
| Rate for Payer: Beech Street Commercial |
$266.95
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.57
|
| Rate for Payer: Cigna of WY Commercial |
$275.38
|
| Rate for Payer: First Choice Health Commercial |
$252.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.84
|
| Rate for Payer: HealthUtah PPO |
$281.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.57
|
| Rate for Payer: Multiplan Medicare/VA |
$53.41
|
| Rate for Payer: One Health Plan of WY PPO |
$275.38
|
| Rate for Payer: PacificSource Commercial |
$252.90
|
| Rate for Payer: PHCS PPO |
$266.95
|
| Rate for Payer: Three Rivers PPO |
$210.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.84
|
| Rate for Payer: United Healthcare Commercial |
$244.47
|
| Rate for Payer: United Healthcare Medicare |
$62.84
|
| Rate for Payer: WINHealth Partners Commercial |
$266.95
|
|
|
PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90839
|
| Min. Negotiated Rate |
$106.99 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$555.66
|
| Rate for Payer: Aetna of WY Medicare |
$125.87
|
| Rate for Payer: Beech Street Commercial |
$538.65
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.99
|
| Rate for Payer: Cigna of WY Commercial |
$555.66
|
| Rate for Payer: First Choice Health Commercial |
$510.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$538.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.87
|
| Rate for Payer: HealthUtah PPO |
$567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.99
|
| Rate for Payer: Multiplan Medicare/VA |
$106.99
|
| Rate for Payer: One Health Plan of WY PPO |
$555.66
|
| Rate for Payer: PacificSource Commercial |
$510.30
|
| Rate for Payer: PHCS PPO |
$538.65
|
| Rate for Payer: Three Rivers PPO |
$425.25
|
| Rate for Payer: TriWest Veterans Administration |
$125.87
|
| Rate for Payer: United Healthcare Commercial |
$493.29
|
| Rate for Payer: United Healthcare Medicare |
$125.87
|
| Rate for Payer: WINHealth Partners Commercial |
$538.65
|
|
|
PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90832
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$66.70
|
| Rate for Payer: Beech Street Commercial |
$187.15
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: First Choice Health Commercial |
$177.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.70
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$187.15
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
|
|
PSYCHOTHERAPY W/PATIENT 45 MINUTES
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90834
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$88.22
|
| Rate for Payer: Beech Street Commercial |
$432.25
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: First Choice Health Commercial |
$409.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.22
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$74.99
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$432.25
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$88.22
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$88.22
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
|
|
PSYCHOTHERAPY W/PATIENT 60 MINUTES
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
90837
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$130.21
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.21
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$110.68
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$130.21
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$130.21
|
| Rate for Payer: WINHealth Partners Commercial |
$488.30
|
|
|
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
90833
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$62.27
|
| Rate for Payer: Beech Street Commercial |
$313.50
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: First Choice Health Commercial |
$297.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.27
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$52.93
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$313.50
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.27
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$62.27
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
|
|
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
90836
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Aetna of WY Medicare |
$78.88
|
| Rate for Payer: Beech Street Commercial |
$394.25
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: First Choice Health Commercial |
$373.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.88
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Multiplan Medicare/VA |
$67.05
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$394.25
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.88
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$78.88
|
| Rate for Payer: WINHealth Partners Commercial |
$394.25
|
|
|
PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
90838
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$104.50
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.50
|
| Rate for Payer: HealthUtah PPO |
$546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Multiplan Medicare/VA |
$88.82
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.50
|
| Rate for Payer: United Healthcare Commercial |
$475.02
|
| Rate for Payer: United Healthcare Medicare |
$104.50
|
| Rate for Payer: WINHealth Partners Commercial |
$518.70
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 8068102200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 8068102200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 3700040514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.50
|
| Rate for Payer: Aetna of WY Medicare |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.49
|
| Rate for Payer: Altius Commercial |
$0.49
|
| Rate for Payer: Beech Street Commercial |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.50
|
| 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 |
$0.30
|
| Rate for Payer: HealthUtah PPO |
$0.51
|
| 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 |
$0.50
|
| Rate for Payer: PacificSource Commercial |
$0.46
|
| Rate for Payer: PHCS PPO |
$0.50
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.30
|
| Rate for Payer: WINHealth Partners Commercial |
$0.50
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 3700040514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.49
|
| Rate for Payer: Altius Commercial |
$0.49
|
| Rate for Payer: Beech Street Commercial |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.42
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.49
|
| Rate for Payer: Cigna of WY Commercial |
$0.50
|
| 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 |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.50
|
| Rate for Payer: PacificSource Commercial |
$0.46
|
| Rate for Payer: PHCS PPO |
$0.50
|
| Rate for Payer: Three Rivers PPO |
$0.38
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.48
|
| Rate for Payer: Wise Provider Network Commercial |
$0.48
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 4098527024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.12
|
| Rate for Payer: Aetna of WY Medicare |
$0.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.12
|
| Rate for Payer: Altius Commercial |
$0.12
|
| Rate for Payer: Beech Street Commercial |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.12
|
| Rate for Payer: Cigna of WY Commercial |
$0.12
|
| Rate for Payer: Entrust Commercial |
$0.11
|
| Rate for Payer: First Choice Health Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.12
|
| Rate for Payer: PacificSource Commercial |
$0.11
|
| Rate for Payer: PHCS PPO |
$0.12
|
| Rate for Payer: Three Rivers PPO |
$0.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.12
|
| Rate for Payer: Wise Provider Network Commercial |
$0.11
|
|
|
PSYLLIUM HUSK 0.4 GRAM CAPSULE [144786]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 4098527024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.12
|
| Rate for Payer: Altius Commercial |
$0.12
|
| Rate for Payer: Beech Street Commercial |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.12
|
| Rate for Payer: Cigna of WY Commercial |
$0.12
|
| Rate for Payer: Entrust Commercial |
$0.11
|
| Rate for Payer: First Choice Health Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.08
|
| Rate for Payer: HealthUtah PPO |
$0.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.12
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.12
|
| Rate for Payer: PacificSource Commercial |
$0.11
|
| Rate for Payer: PHCS PPO |
$0.12
|
| Rate for Payer: Three Rivers PPO |
$0.09
|
| Rate for Payer: TriWest Veterans Administration |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.08
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.11
|
|
|
PSYLLIUM HUSK 0.52 GRAM CAPSULE [27780]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 4612210006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
