|
ROPINIROLE 1 MG TABLET [1928]
|
Facility
|
IP
|
$2.32
|
|
|
Service Code
|
NDC 6068758811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.23
|
| Rate for Payer: Altius Commercial |
$2.23
|
| Rate for Payer: Beech Street Commercial |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.25
|
| Rate for Payer: Cigna of WY Commercial |
$2.27
|
| Rate for Payer: Entrust Commercial |
$2.20
|
| Rate for Payer: First Choice Health Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.53
|
| Rate for Payer: HealthUtah PPO |
$2.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.27
|
| Rate for Payer: PacificSource Commercial |
$2.09
|
| Rate for Payer: PHCS PPO |
$2.27
|
| Rate for Payer: Three Rivers PPO |
$1.74
|
| Rate for Payer: TriWest Veterans Administration |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.02
|
| Rate for Payer: United Healthcare Medicare |
$1.53
|
| Rate for Payer: WINHealth Partners Commercial |
$2.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2.20
|
|
|
ROPINIROLE 1 MG TABLET [1928]
|
Facility
|
OP
|
$2.32
|
|
|
Service Code
|
NDC 6068758801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.27
|
| Rate for Payer: Aetna of WY Medicare |
$1.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.23
|
| Rate for Payer: Altius Commercial |
$2.23
|
| Rate for Payer: Beech Street Commercial |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.25
|
| Rate for Payer: Cigna of WY Commercial |
$2.27
|
| Rate for Payer: Entrust Commercial |
$2.20
|
| Rate for Payer: First Choice Health Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.35
|
| Rate for Payer: HealthUtah PPO |
$2.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2.27
|
| Rate for Payer: PacificSource Commercial |
$2.09
|
| Rate for Payer: PHCS PPO |
$2.27
|
| Rate for Payer: Three Rivers PPO |
$1.74
|
| Rate for Payer: TriWest Veterans Administration |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$2.02
|
| Rate for Payer: United Healthcare Medicare |
$1.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2.27
|
| Rate for Payer: Wise Provider Network Commercial |
$2.20
|
|
|
ROPINIROLE 1 MG TABLET [1928]
|
Facility
|
IP
|
$2.32
|
|
|
Service Code
|
NDC 6068758801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.23
|
| Rate for Payer: Altius Commercial |
$2.23
|
| Rate for Payer: Beech Street Commercial |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.25
|
| Rate for Payer: Cigna of WY Commercial |
$2.27
|
| Rate for Payer: Entrust Commercial |
$2.20
|
| Rate for Payer: First Choice Health Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.53
|
| Rate for Payer: HealthUtah PPO |
$2.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.27
|
| Rate for Payer: PacificSource Commercial |
$2.09
|
| Rate for Payer: PHCS PPO |
$2.27
|
| Rate for Payer: Three Rivers PPO |
$1.74
|
| Rate for Payer: TriWest Veterans Administration |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.02
|
| Rate for Payer: United Healthcare Medicare |
$1.53
|
| Rate for Payer: WINHealth Partners Commercial |
$2.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2.20
|
|
|
ROPINIROLE 1 MG TABLET [1928]
|
Facility
|
OP
|
$2.32
|
|
|
Service Code
|
NDC 6068758811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.27
|
| Rate for Payer: Aetna of WY Medicare |
$1.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.23
|
| Rate for Payer: Altius Commercial |
$2.23
|
| Rate for Payer: Beech Street Commercial |
$2.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.25
|
| Rate for Payer: Cigna of WY Commercial |
$2.27
|
| Rate for Payer: Entrust Commercial |
$2.20
|
| Rate for Payer: First Choice Health Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.35
|
| Rate for Payer: HealthUtah PPO |
$2.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2.27
|
| Rate for Payer: PacificSource Commercial |
$2.09
|
| Rate for Payer: PHCS PPO |
$2.27
|
| Rate for Payer: Three Rivers PPO |
$1.74
|
| Rate for Payer: TriWest Veterans Administration |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$2.02
|
| Rate for Payer: United Healthcare Medicare |
$1.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2.27
|
| Rate for Payer: Wise Provider Network Commercial |
$2.20
|
|
|
ROPINIROLE ER 2 MG TABLET,EXTENDED RELEASE 24 HR [53435]
|
Facility
|
IP
|
$8.62
|
|
|
Service Code
|
NDC 0228365803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.28
|
| Rate for Payer: Altius Commercial |
$8.28
|
| Rate for Payer: Beech Street Commercial |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.36
|
| Rate for Payer: Cigna of WY Commercial |
$8.45
|
| Rate for Payer: Entrust Commercial |
$8.19
|
| Rate for Payer: First Choice Health Commercial |
$8.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.69
|
| Rate for Payer: HealthUtah PPO |
$8.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.36
|
| Rate for Payer: Multiplan Medicare/VA |
$5.40
|
| Rate for Payer: One Health Plan of WY PPO |
$8.45
|
| Rate for Payer: PacificSource Commercial |
$7.76
|
| Rate for Payer: PHCS PPO |
$8.45
|
| Rate for Payer: Three Rivers PPO |
$6.46
|
| Rate for Payer: TriWest Veterans Administration |
$5.69
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$5.69
|
| Rate for Payer: WINHealth Partners Commercial |
$8.19
|
| Rate for Payer: Wise Provider Network Commercial |
$8.19
|
|
|
ROPINIROLE ER 2 MG TABLET,EXTENDED RELEASE 24 HR [53435]
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
NDC 0228365803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.45
|
| Rate for Payer: Aetna of WY Medicare |
$5.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.28
|
| Rate for Payer: Altius Commercial |
$8.28
|
| Rate for Payer: Beech Street Commercial |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.36
|
| Rate for Payer: Cigna of WY Commercial |
$8.45
|
| Rate for Payer: Entrust Commercial |
$8.19
|
| Rate for Payer: First Choice Health Commercial |
$8.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.00
|
| Rate for Payer: HealthUtah PPO |
$8.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.36
|
| Rate for Payer: Multiplan Medicare/VA |
$4.75
|
| Rate for Payer: One Health Plan of WY PPO |
$8.45
|
| Rate for Payer: PacificSource Commercial |
$7.76
|
| Rate for Payer: PHCS PPO |
$8.45
|
| Rate for Payer: Three Rivers PPO |
$6.46
|
| Rate for Payer: TriWest Veterans Administration |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$5.00
|
| Rate for Payer: WINHealth Partners Commercial |
$8.45
|
| Rate for Payer: Wise Provider Network Commercial |
$8.19
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [8560]
|
Facility
|
IP
|
$16.55
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.58
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.28
|
| Rate for Payer: Altius Commercial |
$16.24
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Altius Commercial |
$16.28
|
| Rate for Payer: Beech Street Commercial |
$16.62
|
| Rate for Payer: Beech Street Commercial |
$16.58
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.89
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.41
|
| Rate for Payer: Cigna of WY Commercial |
$16.58
|
| Rate for Payer: Cigna of WY Commercial |
$16.62
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Entrust Commercial |
$16.11
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: Entrust Commercial |
$16.07
|
| Rate for Payer: First Choice Health Commercial |
$16.07
|
| Rate for Payer: First Choice Health Commercial |
$16.11
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.19
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: HealthUtah PPO |
$16.92
|
| Rate for Payer: HealthUtah PPO |
$16.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Multiplan Medicare/VA |
$10.63
|
| Rate for Payer: Multiplan Medicare/VA |
$10.38
|
| Rate for Payer: Multiplan Medicare/VA |
$10.61
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: One Health Plan of WY PPO |
$16.58
|
| Rate for Payer: One Health Plan of WY PPO |
$16.62
|
| Rate for Payer: PacificSource Commercial |
$15.26
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$15.23
|
| Rate for Payer: PHCS PPO |
$16.58
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: PHCS PPO |
$16.62
|
| Rate for Payer: Three Rivers PPO |
$12.69
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: Three Rivers PPO |
$12.72
|
| Rate for Payer: TriWest Veterans Administration |
$11.17
|
| Rate for Payer: TriWest Veterans Administration |
$10.92
|
| Rate for Payer: TriWest Veterans Administration |
$11.19
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$10.92
|
| Rate for Payer: United Healthcare Medicare |
$11.19
|
| Rate for Payer: United Healthcare Medicare |
$11.17
|
| Rate for Payer: WINHealth Partners Commercial |
$16.07
|
| Rate for Payer: WINHealth Partners Commercial |
$15.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.11
|
| Rate for Payer: Wise Provider Network Commercial |
$16.11
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
| Rate for Payer: Wise Provider Network Commercial |
$16.07
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [8560]
|
Facility
|
OP
|
$16.92
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.58
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.62
|
| Rate for Payer: Aetna of WY Medicare |
$11.17
|
| Rate for Payer: Aetna of WY Medicare |
$11.19
|
| Rate for Payer: Aetna of WY Medicare |
$10.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.28
|
| Rate for Payer: Altius Commercial |
$16.24
|
| Rate for Payer: Altius Commercial |
$16.28
|
| Rate for Payer: Altius Commercial |
$15.89
|
| Rate for Payer: Beech Street Commercial |
$16.58
|
| Rate for Payer: Beech Street Commercial |
$16.62
|
| Rate for Payer: Beech Street Commercial |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.62
|
| Rate for Payer: Cigna of WY Commercial |
$16.22
|
| Rate for Payer: Cigna of WY Commercial |
$16.58
|
| Rate for Payer: Entrust Commercial |
$16.11
|
| Rate for Payer: Entrust Commercial |
$16.07
|
| Rate for Payer: Entrust Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$16.07
|
| Rate for Payer: First Choice Health Commercial |
$15.72
|
| Rate for Payer: First Choice Health Commercial |
$16.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.84
|
| Rate for Payer: HealthUtah PPO |
$16.55
|
| Rate for Payer: HealthUtah PPO |
$16.96
|
| Rate for Payer: HealthUtah PPO |
$16.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.41
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: Multiplan Medicare/VA |
$9.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.34
|
| Rate for Payer: One Health Plan of WY PPO |
$16.22
|
| Rate for Payer: One Health Plan of WY PPO |
$16.62
|
| Rate for Payer: One Health Plan of WY PPO |
$16.58
|
| Rate for Payer: PacificSource Commercial |
$15.26
|
| Rate for Payer: PacificSource Commercial |
$15.23
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.58
|
| Rate for Payer: PHCS PPO |
$16.22
|
| Rate for Payer: PHCS PPO |
$16.62
|
| Rate for Payer: Three Rivers PPO |
$12.69
|
| Rate for Payer: Three Rivers PPO |
$12.41
|
| Rate for Payer: Three Rivers PPO |
$12.72
|
| Rate for Payer: TriWest Veterans Administration |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$9.81
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$14.40
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Commercial |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: United Healthcare Medicare |
$9.81
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: WINHealth Partners Commercial |
$16.22
|
| Rate for Payer: WINHealth Partners Commercial |
$16.58
|
| Rate for Payer: Wise Provider Network Commercial |
$15.72
|
| Rate for Payer: Wise Provider Network Commercial |
$16.11
|
| Rate for Payer: Wise Provider Network Commercial |
$16.07
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [93175]
|
Facility
|
IP
|
$18.01
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.29
|
| Rate for Payer: Altius Commercial |
$17.29
|
| Rate for Payer: Beech Street Commercial |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.79
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.47
|
| Rate for Payer: Cigna of WY Commercial |
$17.65
|
| Rate for Payer: Entrust Commercial |
$17.11
|
| Rate for Payer: First Choice Health Commercial |
$17.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.89
|
| Rate for Payer: HealthUtah PPO |
$18.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.47
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.65
|
| Rate for Payer: PacificSource Commercial |
$16.21
|
| Rate for Payer: PHCS PPO |
$17.65
|
| Rate for Payer: Three Rivers PPO |
$13.51
|
| Rate for Payer: TriWest Veterans Administration |
$11.89
|
| Rate for Payer: United Healthcare Commercial |
$15.67
|
| Rate for Payer: United Healthcare Medicare |
$11.89
|
| Rate for Payer: WINHealth Partners Commercial |
$17.11
|
| Rate for Payer: Wise Provider Network Commercial |
$17.11
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [93175]
|
Facility
|
OP
|
$18.01
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.65
|
| Rate for Payer: Aetna of WY Medicare |
$11.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.29
|
| Rate for Payer: Altius Commercial |
$17.29
|
| Rate for Payer: Beech Street Commercial |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.79
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.47
|
| Rate for Payer: Cigna of WY Commercial |
$17.65
|
| Rate for Payer: Entrust Commercial |
$17.11
|
| Rate for Payer: First Choice Health Commercial |
$17.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.45
|
| Rate for Payer: HealthUtah PPO |
$18.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.47
|
| Rate for Payer: Multiplan Medicare/VA |
$9.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.65
|
| Rate for Payer: PacificSource Commercial |
$16.21
|
| Rate for Payer: PHCS PPO |
$17.65
|
| Rate for Payer: Three Rivers PPO |
$13.51
|
| Rate for Payer: TriWest Veterans Administration |
$10.45
|
| Rate for Payer: United Healthcare Commercial |
$15.67
|
| Rate for Payer: United Healthcare Medicare |
$10.45
|
| Rate for Payer: WINHealth Partners Commercial |
$17.65
|
| Rate for Payer: Wise Provider Network Commercial |
$17.11
|
|
|
ROSA ROBOTIC UNIT DRAPE
|
Facility
|
IP
|
$255.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.49 |
| Max. Negotiated Rate |
$255.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.72
|
| Rate for Payer: Altius Commercial |
$245.72
|
| Rate for Payer: Beech Street Commercial |
$250.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.14
|
| Rate for Payer: Cash Price |
$179.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.28
|
| Rate for Payer: Cigna of WY Commercial |
$250.84
|
| Rate for Payer: Entrust Commercial |
$243.16
|
| Rate for Payer: First Choice Health Commercial |
$243.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.93
|
| Rate for Payer: HealthUtah PPO |
$255.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.28
|
| Rate for Payer: Multiplan Medicare/VA |
$160.49
|
| Rate for Payer: One Health Plan of WY PPO |
$250.84
|
| Rate for Payer: PacificSource Commercial |
$230.36
|
| Rate for Payer: PHCS PPO |
$250.84
|
| Rate for Payer: Three Rivers PPO |
$191.97
|
| Rate for Payer: TriWest Veterans Administration |
$168.93
|
| Rate for Payer: United Healthcare Commercial |
$222.69
|
| Rate for Payer: United Healthcare Medicare |
$168.93
|
| Rate for Payer: WINHealth Partners Commercial |
$243.16
|
| Rate for Payer: Wise Provider Network Commercial |
$243.16
|
|
|
ROSA ROBOTIC UNIT DRAPE
|
Facility
|
OP
|
$255.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.03 |
| Max. Negotiated Rate |
$255.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.84
|
| Rate for Payer: Aetna of WY Medicare |
$168.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.72
|
| Rate for Payer: Altius Commercial |
$245.72
|
| Rate for Payer: Beech Street Commercial |
$250.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.14
|
| Rate for Payer: Cash Price |
$179.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.28
|
| Rate for Payer: Cigna of WY Commercial |
$250.84
|
| Rate for Payer: Entrust Commercial |
$243.16
|
| Rate for Payer: First Choice Health Commercial |
$243.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.46
|
| Rate for Payer: HealthUtah PPO |
$255.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.28
|
| Rate for Payer: Multiplan Medicare/VA |
$141.03
|
| Rate for Payer: One Health Plan of WY PPO |
$250.84
|
| Rate for Payer: PacificSource Commercial |
$230.36
|
| Rate for Payer: PHCS PPO |
$250.84
|
| Rate for Payer: Three Rivers PPO |
$191.97
|
| Rate for Payer: TriWest Veterans Administration |
$148.46
|
| Rate for Payer: United Healthcare Commercial |
$222.69
|
| Rate for Payer: United Healthcare Medicare |
$148.46
|
| Rate for Payer: WINHealth Partners Commercial |
$250.84
|
| Rate for Payer: Wise Provider Network Commercial |
$243.16
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [40303]
|
Facility
|
OP
|
$98.07
|
|
|
Service Code
|
NDC 0006404741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.04 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.11
|
| Rate for Payer: Aetna of WY Medicare |
$64.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.15
|
| Rate for Payer: Altius Commercial |
$94.15
|
| Rate for Payer: Beech Street Commercial |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.52
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.13
|
| Rate for Payer: Cigna of WY Commercial |
$96.11
|
| Rate for Payer: Entrust Commercial |
$93.17
|
| Rate for Payer: First Choice Health Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.88
|
| Rate for Payer: HealthUtah PPO |
$98.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.13
|
| Rate for Payer: Multiplan Medicare/VA |
$54.04
|
| Rate for Payer: One Health Plan of WY PPO |
$96.11
|
| Rate for Payer: PacificSource Commercial |
$88.26
|
| Rate for Payer: PHCS PPO |
$96.11
|
| Rate for Payer: Three Rivers PPO |
$73.55
|
| Rate for Payer: TriWest Veterans Administration |
$56.88
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$56.88
|
| Rate for Payer: WINHealth Partners Commercial |
$96.11
|
| Rate for Payer: Wise Provider Network Commercial |
$93.17
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [40303]
|
Facility
|
IP
|
$98.07
|
|
|
Service Code
|
NDC 0006404741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.15
|
| Rate for Payer: Altius Commercial |
$94.15
|
| Rate for Payer: Beech Street Commercial |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.52
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.13
|
| Rate for Payer: Cigna of WY Commercial |
$96.11
|
| Rate for Payer: Entrust Commercial |
$93.17
|
| Rate for Payer: First Choice Health Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.73
|
| Rate for Payer: HealthUtah PPO |
$98.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.13
|
| Rate for Payer: Multiplan Medicare/VA |
$61.49
|
| Rate for Payer: One Health Plan of WY PPO |
$96.11
|
| Rate for Payer: PacificSource Commercial |
$88.26
|
| Rate for Payer: PHCS PPO |
$96.11
|
| Rate for Payer: Three Rivers PPO |
$73.55
|
| Rate for Payer: TriWest Veterans Administration |
$64.73
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$64.73
|
| Rate for Payer: WINHealth Partners Commercial |
$93.17
|
| Rate for Payer: Wise Provider Network Commercial |
$93.17
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [40303]
|
Facility
|
IP
|
$98.07
|
|
|
Service Code
|
NDC 0006404702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.15
|
| Rate for Payer: Altius Commercial |
$94.15
|
| Rate for Payer: Beech Street Commercial |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.52
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.13
|
| Rate for Payer: Cigna of WY Commercial |
$96.11
|
| Rate for Payer: Entrust Commercial |
$93.17
|
| Rate for Payer: First Choice Health Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.73
|
| Rate for Payer: HealthUtah PPO |
$98.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.13
|
| Rate for Payer: Multiplan Medicare/VA |
$61.49
|
| Rate for Payer: One Health Plan of WY PPO |
$96.11
|
| Rate for Payer: PacificSource Commercial |
$88.26
|
| Rate for Payer: PHCS PPO |
$96.11
|
| Rate for Payer: Three Rivers PPO |
$73.55
|
| Rate for Payer: TriWest Veterans Administration |
$64.73
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$64.73
|
| Rate for Payer: WINHealth Partners Commercial |
$93.17
|
| Rate for Payer: Wise Provider Network Commercial |
$93.17
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION [40303]
|
Facility
|
OP
|
$98.07
|
|
|
Service Code
|
NDC 0006404702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.04 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.11
|
| Rate for Payer: Aetna of WY Medicare |
$64.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.15
|
| Rate for Payer: Altius Commercial |
$94.15
|
| Rate for Payer: Beech Street Commercial |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.52
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.13
|
| Rate for Payer: Cigna of WY Commercial |
$96.11
|
| Rate for Payer: Entrust Commercial |
$93.17
|
| Rate for Payer: First Choice Health Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.88
|
| Rate for Payer: HealthUtah PPO |
$98.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.13
|
| Rate for Payer: Multiplan Medicare/VA |
$54.04
|
| Rate for Payer: One Health Plan of WY PPO |
$96.11
|
| Rate for Payer: PacificSource Commercial |
$88.26
|
| Rate for Payer: PHCS PPO |
$96.11
|
| Rate for Payer: Three Rivers PPO |
$73.55
|
| Rate for Payer: TriWest Veterans Administration |
$56.88
|
| Rate for Payer: United Healthcare Commercial |
$85.32
|
| Rate for Payer: United Healthcare Medicare |
$56.88
|
| Rate for Payer: WINHealth Partners Commercial |
$96.11
|
| Rate for Payer: Wise Provider Network Commercial |
$93.17
|
|
|
ROTH NET-FOREIGN BODY
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.90
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$197.50
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
| Rate for Payer: WINHealth Partners Commercial |
$299.25
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
ROTH NET-FOREIGN BODY
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$207.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.70
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$173.56
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$182.70
|
| Rate for Payer: WINHealth Partners Commercial |
$308.70
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$6,702.00
|
|
|
Service Code
|
HCPCS 59610
|
| Hospital Charge Code |
59610
|
| Min. Negotiated Rate |
$2,043.58 |
| Max. Negotiated Rate |
$6,702.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,567.96
|
| Rate for Payer: Aetna of WY Medicare |
$2,404.21
|
| Rate for Payer: Beech Street Commercial |
$6,366.90
|
| Rate for Payer: Cash Price |
$4,691.40
|
| Rate for Payer: Cash Price |
$4,691.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,500.94
|
| Rate for Payer: Cigna of WY Commercial |
$6,567.96
|
| Rate for Payer: First Choice Health Commercial |
$6,031.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,366.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,404.21
|
| Rate for Payer: HealthUtah PPO |
$6,702.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,500.94
|
| Rate for Payer: Multiplan Medicare/VA |
$2,043.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,567.96
|
| Rate for Payer: PacificSource Commercial |
$6,031.80
|
| Rate for Payer: PHCS PPO |
$6,366.90
|
| Rate for Payer: Three Rivers PPO |
$5,026.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,404.21
|
| Rate for Payer: United Healthcare Commercial |
$5,830.74
|
| Rate for Payer: United Healthcare Medicare |
$2,404.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5,696.70
|
|
|
ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$7,157.00
|
|
|
Service Code
|
HCPCS 59618
|
| Hospital Charge Code |
59618
|
| Min. Negotiated Rate |
$2,190.54 |
| Max. Negotiated Rate |
$7,157.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,013.86
|
| Rate for Payer: Aetna of WY Medicare |
$2,577.11
|
| Rate for Payer: Beech Street Commercial |
$6,799.15
|
| Rate for Payer: Cash Price |
$5,009.90
|
| Rate for Payer: Cash Price |
$5,009.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,942.29
|
| Rate for Payer: Cigna of WY Commercial |
$7,013.86
|
| Rate for Payer: First Choice Health Commercial |
$6,441.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,799.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,577.11
|
| Rate for Payer: HealthUtah PPO |
$7,157.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,942.29
|
| Rate for Payer: Multiplan Medicare/VA |
$2,190.54
|
| Rate for Payer: One Health Plan of WY PPO |
$7,013.86
|
| Rate for Payer: PacificSource Commercial |
$6,441.30
|
| Rate for Payer: PHCS PPO |
$6,799.15
|
| Rate for Payer: Three Rivers PPO |
$5,367.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,577.11
|
| Rate for Payer: United Healthcare Commercial |
$6,226.59
|
| Rate for Payer: United Healthcare Medicare |
$2,577.11
|
| Rate for Payer: WINHealth Partners Commercial |
$6,083.45
|
|
|
RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$3,270.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$513.59 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,204.60
|
| Rate for Payer: Aetna of WY Medicare |
$604.22
|
| Rate for Payer: Beech Street Commercial |
$3,106.50
|
| Rate for Payer: Cash Price |
$2,289.00
|
| Rate for Payer: Cash Price |
$2,289.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,171.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,204.60
|
| Rate for Payer: First Choice Health Commercial |
$2,943.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,106.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.22
|
| Rate for Payer: HealthUtah PPO |
$3,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,171.90
|
| Rate for Payer: Multiplan Medicare/VA |
$513.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,204.60
|
| Rate for Payer: PacificSource Commercial |
$2,943.00
|
| Rate for Payer: PHCS PPO |
$3,106.50
|
| Rate for Payer: Three Rivers PPO |
$2,452.50
|
| Rate for Payer: TriWest Veterans Administration |
$604.22
|
| Rate for Payer: United Healthcare Commercial |
$2,844.90
|
| Rate for Payer: United Healthcare Medicare |
$604.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,779.50
|
|
|
RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$469.82 |
| Max. Negotiated Rate |
$1,973.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,933.54
|
| Rate for Payer: Aetna of WY Medicare |
$552.73
|
| Rate for Payer: Beech Street Commercial |
$1,874.35
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: Cash Price |
$1,381.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,913.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,933.54
|
| Rate for Payer: First Choice Health Commercial |
$1,775.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,874.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.73
|
| Rate for Payer: HealthUtah PPO |
$1,973.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,913.81
|
| Rate for Payer: Multiplan Medicare/VA |
$469.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,933.54
|
| Rate for Payer: PacificSource Commercial |
$1,775.70
|
| Rate for Payer: PHCS PPO |
$1,874.35
|
| Rate for Payer: Three Rivers PPO |
$1,479.75
|
| Rate for Payer: TriWest Veterans Administration |
$552.73
|
| Rate for Payer: United Healthcare Commercial |
$1,716.51
|
| Rate for Payer: United Healthcare Medicare |
$552.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,677.05
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$3,035.00
|
|
|
Service Code
|
HCPCS 49507 80
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$3,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,974.30
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$2,883.25
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,943.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,974.30
|
| Rate for Payer: First Choice Health Commercial |
$2,731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,883.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$3,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,943.95
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,974.30
|
| Rate for Payer: PacificSource Commercial |
$2,731.50
|
| Rate for Payer: PHCS PPO |
$2,883.25
|
| Rate for Payer: Three Rivers PPO |
$2,276.25
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$2,640.45
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,579.75
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$3,035.00
|
|
|
Service Code
|
HCPCS 49507 AS
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$3,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,974.30
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$2,883.25
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,943.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,974.30
|
| Rate for Payer: First Choice Health Commercial |
$2,731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,883.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$3,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,943.95
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,974.30
|
| Rate for Payer: PacificSource Commercial |
$2,731.50
|
| Rate for Payer: PHCS PPO |
$2,883.25
|
| Rate for Payer: Three Rivers PPO |
$2,276.25
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$2,640.45
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$2,579.75
|
|
|
RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$6,070.00
|
|
|
Service Code
|
HCPCS 49507 50
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$6,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,948.60
|
| Rate for Payer: Aetna of WY Medicare |
$562.38
|
| Rate for Payer: Beech Street Commercial |
$5,766.50
|
| Rate for Payer: Cash Price |
$4,249.00
|
| Rate for Payer: Cash Price |
$4,249.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,887.90
|
| Rate for Payer: Cigna of WY Commercial |
$5,948.60
|
| Rate for Payer: First Choice Health Commercial |
$5,463.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,766.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.38
|
| Rate for Payer: HealthUtah PPO |
$6,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,887.90
|
| Rate for Payer: Multiplan Medicare/VA |
$478.02
|
| Rate for Payer: One Health Plan of WY PPO |
$5,948.60
|
| Rate for Payer: PacificSource Commercial |
$5,463.00
|
| Rate for Payer: PHCS PPO |
$5,766.50
|
| Rate for Payer: Three Rivers PPO |
$4,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.38
|
| Rate for Payer: United Healthcare Commercial |
$5,280.90
|
| Rate for Payer: United Healthcare Medicare |
$562.38
|
| Rate for Payer: WINHealth Partners Commercial |
$5,159.50
|
|
