|
TRANSECTION/AVULSION OTH SPINAL NRV XDRL
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 64772 AS
|
| Hospital Charge Code |
64772
|
| Min. Negotiated Rate |
$460.16 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,850.82
|
| Rate for Payer: Aetna of WY Medicare |
$541.37
|
| Rate for Payer: Beech Street Commercial |
$2,763.55
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,821.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,850.82
|
| Rate for Payer: First Choice Health Commercial |
$2,618.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,763.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.37
|
| Rate for Payer: HealthUtah PPO |
$2,909.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,821.73
|
| Rate for Payer: Multiplan Medicare/VA |
$460.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,850.82
|
| Rate for Payer: PacificSource Commercial |
$2,618.10
|
| Rate for Payer: PHCS PPO |
$2,763.55
|
| Rate for Payer: Three Rivers PPO |
$2,181.75
|
| Rate for Payer: TriWest Veterans Administration |
$541.37
|
| Rate for Payer: United Healthcare Commercial |
$2,530.83
|
| Rate for Payer: United Healthcare Medicare |
$541.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,472.65
|
|
|
TRANSECTION/AVULSION OTH SPINAL NRV XDRL
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
64772
|
| Min. Negotiated Rate |
$460.16 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,850.82
|
| Rate for Payer: Aetna of WY Medicare |
$541.37
|
| Rate for Payer: Beech Street Commercial |
$2,763.55
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: Cash Price |
$2,036.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,821.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,850.82
|
| Rate for Payer: First Choice Health Commercial |
$2,618.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,763.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.37
|
| Rate for Payer: HealthUtah PPO |
$2,909.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,821.73
|
| Rate for Payer: Multiplan Medicare/VA |
$460.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,850.82
|
| Rate for Payer: PacificSource Commercial |
$2,618.10
|
| Rate for Payer: PHCS PPO |
$2,763.55
|
| Rate for Payer: Three Rivers PPO |
$2,181.75
|
| Rate for Payer: TriWest Veterans Administration |
$541.37
|
| Rate for Payer: United Healthcare Commercial |
$2,530.83
|
| Rate for Payer: United Healthcare Medicare |
$541.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,472.65
|
|
|
TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH
|
Professional
|
Both
|
$2,921.00
|
|
|
Service Code
|
HCPCS 26485
|
| Hospital Charge Code |
26485
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,862.58
|
| Rate for Payer: Aetna of WY Medicare |
$818.88
|
| Rate for Payer: Beech Street Commercial |
$2,774.95
|
| Rate for Payer: Cash Price |
$2,044.70
|
| Rate for Payer: Cash Price |
$2,044.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,833.37
|
| Rate for Payer: Cigna of WY Commercial |
$2,862.58
|
| Rate for Payer: First Choice Health Commercial |
$2,628.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,774.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$818.88
|
| Rate for Payer: HealthUtah PPO |
$2,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,833.37
|
| Rate for Payer: Multiplan Medicare/VA |
$696.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,862.58
|
| Rate for Payer: PacificSource Commercial |
$2,628.90
|
| Rate for Payer: PHCS PPO |
$2,774.95
|
| Rate for Payer: Three Rivers PPO |
$2,190.75
|
| Rate for Payer: TriWest Veterans Administration |
$818.88
|
| Rate for Payer: United Healthcare Commercial |
$2,541.27
|
| Rate for Payer: United Healthcare Medicare |
$818.88
|
| Rate for Payer: WINHealth Partners Commercial |
$2,482.85
|
|
|
TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
99496
|
| Min. Negotiated Rate |
$155.51 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$787.92
|
| Rate for Payer: Aetna of WY Medicare |
$182.95
|
| Rate for Payer: Beech Street Commercial |
$763.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$779.88
|
| Rate for Payer: Cigna of WY Commercial |
$787.92
|
| Rate for Payer: First Choice Health Commercial |
$723.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$763.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.95
|
| Rate for Payer: HealthUtah PPO |
$804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$779.88
|
| Rate for Payer: Multiplan Medicare/VA |
$155.51
|
| Rate for Payer: One Health Plan of WY PPO |
$787.92
|
| Rate for Payer: PacificSource Commercial |
$723.60
|
| Rate for Payer: PHCS PPO |
$763.80
|
| Rate for Payer: Three Rivers PPO |
$603.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.95
|
| Rate for Payer: United Healthcare Commercial |
$699.48
|
| Rate for Payer: United Healthcare Medicare |
$182.95
|
| Rate for Payer: WINHealth Partners Commercial |
$763.80
|
|
|
TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
99495
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Aetna of WY Medicare |
$134.68
|
| Rate for Payer: Beech Street Commercial |
$579.50
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: First Choice Health Commercial |
$549.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.68
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$114.48
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$579.50
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$134.68
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$134.68
|
| Rate for Payer: WINHealth Partners Commercial |
$579.50
|
|
|
TRANSSPEC DEV WPERF PLT
|
Facility
|
OP
|
$179.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.30
|
| Rate for Payer: Aetna of WY Medicare |
$118.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.70
|
| Rate for Payer: Altius Commercial |
$172.70
|
| Rate for Payer: Beech Street Commercial |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.70
|
| Rate for Payer: Cash Price |
$125.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.50
|
| Rate for Payer: Cigna of WY Commercial |
$176.30
|
| Rate for Payer: Entrust Commercial |
$170.90
|
| Rate for Payer: First Choice Health Commercial |
$170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.34
|
| Rate for Payer: HealthUtah PPO |
$179.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.50
|
| Rate for Payer: Multiplan Medicare/VA |
$99.12
|
| Rate for Payer: One Health Plan of WY PPO |
$176.30
|
| Rate for Payer: PacificSource Commercial |
$161.91
|
| Rate for Payer: PHCS PPO |
$176.30
|
| Rate for Payer: Three Rivers PPO |
$134.92
|
| Rate for Payer: TriWest Veterans Administration |
$104.34
|
| Rate for Payer: United Healthcare Commercial |
$156.51
|
| Rate for Payer: United Healthcare Medicare |
$104.34
|
| Rate for Payer: WINHealth Partners Commercial |
$176.30
|
| Rate for Payer: Wise Provider Network Commercial |
$170.90
|
|
|
TRANSSPEC DEV WPERF PLT
|
Facility
|
IP
|
$179.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.70
|
| Rate for Payer: Altius Commercial |
$172.70
|
| Rate for Payer: Beech Street Commercial |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.70
|
| Rate for Payer: Cash Price |
$125.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.50
|
| Rate for Payer: Cigna of WY Commercial |
$176.30
|
| Rate for Payer: Entrust Commercial |
$170.90
|
| Rate for Payer: First Choice Health Commercial |
$170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.73
|
| Rate for Payer: HealthUtah PPO |
$179.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.50
|
| Rate for Payer: Multiplan Medicare/VA |
$112.80
|
| Rate for Payer: One Health Plan of WY PPO |
$176.30
|
| Rate for Payer: PacificSource Commercial |
$161.91
|
| Rate for Payer: PHCS PPO |
$176.30
|
| Rate for Payer: Three Rivers PPO |
$134.92
|
| Rate for Payer: TriWest Veterans Administration |
$118.73
|
| Rate for Payer: United Healthcare Commercial |
$156.51
|
| Rate for Payer: United Healthcare Medicare |
$118.73
|
| Rate for Payer: WINHealth Partners Commercial |
$170.90
|
| Rate for Payer: Wise Provider Network Commercial |
$170.90
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [149014]
|
Facility
|
IP
|
$1,573.42
|
|
|
Service Code
|
HCPCS J9355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$986.53 |
| Max. Negotiated Rate |
$1,573.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,541.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,510.48
|
| Rate for Payer: Altius Commercial |
$1,510.48
|
| Rate for Payer: Beech Street Commercial |
$1,541.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,291.78
|
| Rate for Payer: Cash Price |
$1,101.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,526.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,541.95
|
| Rate for Payer: Entrust Commercial |
$1,494.75
|
| Rate for Payer: First Choice Health Commercial |
$1,494.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,494.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,038.46
|
| Rate for Payer: HealthUtah PPO |
$1,573.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$986.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,541.95
|
| Rate for Payer: PacificSource Commercial |
$1,416.08
|
| Rate for Payer: PHCS PPO |
$1,541.95
|
| Rate for Payer: Three Rivers PPO |
$1,180.06
|
| Rate for Payer: TriWest Veterans Administration |
$1,038.46
|
| Rate for Payer: United Healthcare Commercial |
$1,368.88
|
| Rate for Payer: United Healthcare Medicare |
$1,038.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,494.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,494.75
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION [149014]
|
Facility
|
OP
|
$1,573.42
|
|
|
Service Code
|
HCPCS J9355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$866.95 |
| Max. Negotiated Rate |
$1,573.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,541.95
|
| Rate for Payer: Aetna of WY Medicare |
$1,038.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,510.48
|
| Rate for Payer: Altius Commercial |
$1,510.48
|
| Rate for Payer: Beech Street Commercial |
$1,541.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,291.78
|
| Rate for Payer: Cash Price |
$1,101.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,526.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,541.95
|
| Rate for Payer: Entrust Commercial |
$1,494.75
|
| Rate for Payer: First Choice Health Commercial |
$1,494.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,494.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$912.58
|
| Rate for Payer: HealthUtah PPO |
$1,573.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,526.22
|
| Rate for Payer: Multiplan Medicare/VA |
$866.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,541.95
|
| Rate for Payer: PacificSource Commercial |
$1,416.08
|
| Rate for Payer: PHCS PPO |
$1,541.95
|
| Rate for Payer: Three Rivers PPO |
$1,180.06
|
| Rate for Payer: TriWest Veterans Administration |
$912.58
|
| Rate for Payer: United Healthcare Commercial |
$1,368.88
|
| Rate for Payer: United Healthcare Medicare |
$912.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,541.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,494.75
|
|
|
TRASTUZUMAB-DKST 150 MG INTRAVENOUS SOLUTION [156897]
|
Facility
|
IP
|
$955.51
|
|
|
Service Code
|
HCPCS Q5114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$599.10 |
| Max. Negotiated Rate |
$955.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,312.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$917.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,286.07
|
| Rate for Payer: Altius Commercial |
$1,286.07
|
| Rate for Payer: Altius Commercial |
$917.29
|
| Rate for Payer: Beech Street Commercial |
$936.40
|
| Rate for Payer: Beech Street Commercial |
$1,312.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$784.47
|
| Rate for Payer: Cash Price |
$668.86
|
| Rate for Payer: Cash Price |
$937.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,299.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$926.84
|
| Rate for Payer: Cigna of WY Commercial |
$936.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,312.87
|
| Rate for Payer: Entrust Commercial |
$1,272.68
|
| Rate for Payer: Entrust Commercial |
$907.73
|
| Rate for Payer: First Choice Health Commercial |
$1,272.68
|
| Rate for Payer: First Choice Health Commercial |
$907.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,272.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$907.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$630.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$884.18
|
| Rate for Payer: HealthUtah PPO |
$955.51
|
| Rate for Payer: HealthUtah PPO |
$1,339.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,299.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$926.84
|
| Rate for Payer: Multiplan Medicare/VA |
$599.10
|
| Rate for Payer: Multiplan Medicare/VA |
$839.97
|
| Rate for Payer: One Health Plan of WY PPO |
$936.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,312.87
|
| Rate for Payer: PacificSource Commercial |
$859.96
|
| Rate for Payer: PacificSource Commercial |
$1,205.69
|
| Rate for Payer: PHCS PPO |
$1,312.87
|
| Rate for Payer: PHCS PPO |
$936.40
|
| Rate for Payer: Three Rivers PPO |
$1,004.74
|
| Rate for Payer: Three Rivers PPO |
$716.63
|
| Rate for Payer: TriWest Veterans Administration |
$630.64
|
| Rate for Payer: TriWest Veterans Administration |
$884.18
|
| Rate for Payer: United Healthcare Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare Commercial |
$831.29
|
| Rate for Payer: United Healthcare Medicare |
$630.64
|
| Rate for Payer: United Healthcare Medicare |
$884.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,272.68
|
| Rate for Payer: WINHealth Partners Commercial |
$907.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1,272.68
|
| Rate for Payer: Wise Provider Network Commercial |
$907.73
|
|
|
TRASTUZUMAB-DKST 150 MG INTRAVENOUS SOLUTION [156897]
|
Facility
|
OP
|
$955.51
|
|
|
Service Code
|
HCPCS Q5114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$526.49 |
| Max. Negotiated Rate |
$955.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$936.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,312.87
|
| Rate for Payer: Aetna of WY Medicare |
$630.64
|
| Rate for Payer: Aetna of WY Medicare |
$884.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,286.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$917.29
|
| Rate for Payer: Altius Commercial |
$917.29
|
| Rate for Payer: Altius Commercial |
$1,286.07
|
| Rate for Payer: Beech Street Commercial |
$1,312.87
|
| Rate for Payer: Beech Street Commercial |
$936.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$784.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.86
|
| Rate for Payer: Cash Price |
$937.76
|
| Rate for Payer: Cash Price |
$668.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$926.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,299.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,312.87
|
| Rate for Payer: Cigna of WY Commercial |
$936.40
|
| Rate for Payer: Entrust Commercial |
$907.73
|
| Rate for Payer: Entrust Commercial |
$1,272.68
|
| Rate for Payer: First Choice Health Commercial |
$1,272.68
|
| Rate for Payer: First Choice Health Commercial |
$907.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,272.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$907.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$554.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$777.00
|
| Rate for Payer: HealthUtah PPO |
$1,339.66
|
| Rate for Payer: HealthUtah PPO |
$955.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,299.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$926.84
|
| Rate for Payer: Multiplan Medicare/VA |
$526.49
|
| Rate for Payer: Multiplan Medicare/VA |
$738.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,312.87
|
| Rate for Payer: One Health Plan of WY PPO |
$936.40
|
| Rate for Payer: PacificSource Commercial |
$859.96
|
| Rate for Payer: PacificSource Commercial |
$1,205.69
|
| Rate for Payer: PHCS PPO |
$1,312.87
|
| Rate for Payer: PHCS PPO |
$936.40
|
| Rate for Payer: Three Rivers PPO |
$1,004.74
|
| Rate for Payer: Three Rivers PPO |
$716.63
|
| Rate for Payer: TriWest Veterans Administration |
$554.20
|
| Rate for Payer: TriWest Veterans Administration |
$777.00
|
| Rate for Payer: United Healthcare Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare Commercial |
$831.29
|
| Rate for Payer: United Healthcare Medicare |
$554.20
|
| Rate for Payer: United Healthcare Medicare |
$777.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,312.87
|
| Rate for Payer: WINHealth Partners Commercial |
$936.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,272.68
|
| Rate for Payer: Wise Provider Network Commercial |
$907.73
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION [161406]
|
Facility
|
IP
|
$1,226.10
|
|
|
Service Code
|
HCPCS Q5116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$768.76 |
| Max. Negotiated Rate |
$1,226.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,201.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,177.06
|
| Rate for Payer: Altius Commercial |
$1,177.06
|
| Rate for Payer: Beech Street Commercial |
$1,201.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,006.63
|
| Rate for Payer: Cash Price |
$858.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,189.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,201.58
|
| Rate for Payer: Entrust Commercial |
$1,164.80
|
| Rate for Payer: First Choice Health Commercial |
$1,164.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,164.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$809.23
|
| Rate for Payer: HealthUtah PPO |
$1,226.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,189.32
|
| Rate for Payer: Multiplan Medicare/VA |
$768.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,201.58
|
| Rate for Payer: PacificSource Commercial |
$1,103.49
|
| Rate for Payer: PHCS PPO |
$1,201.58
|
| Rate for Payer: Three Rivers PPO |
$919.58
|
| Rate for Payer: TriWest Veterans Administration |
$809.23
|
| Rate for Payer: United Healthcare Commercial |
$1,066.71
|
| Rate for Payer: United Healthcare Medicare |
$809.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,164.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,164.80
|
|
|
TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION [161406]
|
Facility
|
OP
|
$1,226.10
|
|
|
Service Code
|
HCPCS Q5116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$675.58 |
| Max. Negotiated Rate |
$1,226.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,201.58
|
| Rate for Payer: Aetna of WY Medicare |
$809.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,177.06
|
| Rate for Payer: Altius Commercial |
$1,177.06
|
| Rate for Payer: Beech Street Commercial |
$1,201.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,006.63
|
| Rate for Payer: Cash Price |
$858.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,189.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,201.58
|
| Rate for Payer: Entrust Commercial |
$1,164.80
|
| Rate for Payer: First Choice Health Commercial |
$1,164.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,164.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$711.14
|
| Rate for Payer: HealthUtah PPO |
$1,226.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,189.32
|
| Rate for Payer: Multiplan Medicare/VA |
$675.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,201.58
|
| Rate for Payer: PacificSource Commercial |
$1,103.49
|
| Rate for Payer: PHCS PPO |
$1,201.58
|
| Rate for Payer: Three Rivers PPO |
$919.58
|
| Rate for Payer: TriWest Veterans Administration |
$711.14
|
| Rate for Payer: United Healthcare Commercial |
$1,066.71
|
| Rate for Payer: United Healthcare Medicare |
$711.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.58
|
| Rate for Payer: Wise Provider Network Commercial |
$1,164.80
|
|
|
TRAY DRY SCRUB DYND70661
|
Facility
|
IP
|
$7.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.75
|
| Rate for Payer: Altius Commercial |
$6.75
|
| Rate for Payer: Beech Street Commercial |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.82
|
| Rate for Payer: Cigna of WY Commercial |
$6.89
|
| Rate for Payer: Entrust Commercial |
$6.68
|
| Rate for Payer: First Choice Health Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$7.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.82
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$6.89
|
| Rate for Payer: PacificSource Commercial |
$6.33
|
| Rate for Payer: PHCS PPO |
$6.89
|
| Rate for Payer: Three Rivers PPO |
$5.27
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$6.68
|
| Rate for Payer: Wise Provider Network Commercial |
$6.68
|
|
|
TRAY DRY SCRUB DYND70661
|
Facility
|
OP
|
$7.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.89
|
| Rate for Payer: Aetna of WY Medicare |
$4.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.75
|
| Rate for Payer: Altius Commercial |
$6.75
|
| Rate for Payer: Beech Street Commercial |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.82
|
| Rate for Payer: Cigna of WY Commercial |
$6.89
|
| Rate for Payer: Entrust Commercial |
$6.68
|
| Rate for Payer: First Choice Health Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.08
|
| Rate for Payer: HealthUtah PPO |
$7.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.82
|
| Rate for Payer: Multiplan Medicare/VA |
$3.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6.89
|
| Rate for Payer: PacificSource Commercial |
$6.33
|
| Rate for Payer: PHCS PPO |
$6.89
|
| Rate for Payer: Three Rivers PPO |
$5.27
|
| Rate for Payer: TriWest Veterans Administration |
$4.08
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.08
|
| Rate for Payer: WINHealth Partners Commercial |
$6.89
|
| Rate for Payer: Wise Provider Network Commercial |
$6.68
|
|
|
TRAY LUMBAR PUNCTURE 22X3.5
|
Facility
|
OP
|
$50.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.48
|
| Rate for Payer: Aetna of WY Medicare |
$33.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.47
|
| Rate for Payer: Altius Commercial |
$48.47
|
| Rate for Payer: Beech Street Commercial |
$49.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.45
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.98
|
| Rate for Payer: Cigna of WY Commercial |
$49.48
|
| Rate for Payer: Entrust Commercial |
$47.97
|
| Rate for Payer: First Choice Health Commercial |
$47.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.28
|
| Rate for Payer: HealthUtah PPO |
$50.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.98
|
| Rate for Payer: Multiplan Medicare/VA |
$27.82
|
| Rate for Payer: One Health Plan of WY PPO |
$49.48
|
| Rate for Payer: PacificSource Commercial |
$45.44
|
| Rate for Payer: PHCS PPO |
$49.48
|
| Rate for Payer: Three Rivers PPO |
$37.87
|
| Rate for Payer: TriWest Veterans Administration |
$29.28
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$29.28
|
| Rate for Payer: WINHealth Partners Commercial |
$49.48
|
| Rate for Payer: Wise Provider Network Commercial |
$47.97
|
|
|
TRAY LUMBAR PUNCTURE 22X3.5
|
Facility
|
IP
|
$50.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.47
|
| Rate for Payer: Altius Commercial |
$48.47
|
| Rate for Payer: Beech Street Commercial |
$49.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.45
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.98
|
| Rate for Payer: Cigna of WY Commercial |
$49.48
|
| Rate for Payer: Entrust Commercial |
$47.97
|
| Rate for Payer: First Choice Health Commercial |
$47.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.32
|
| Rate for Payer: HealthUtah PPO |
$50.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.98
|
| Rate for Payer: Multiplan Medicare/VA |
$31.66
|
| Rate for Payer: One Health Plan of WY PPO |
$49.48
|
| Rate for Payer: PacificSource Commercial |
$45.44
|
| Rate for Payer: PHCS PPO |
$49.48
|
| Rate for Payer: Three Rivers PPO |
$37.87
|
| Rate for Payer: TriWest Veterans Administration |
$33.32
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$33.32
|
| Rate for Payer: WINHealth Partners Commercial |
$47.97
|
| Rate for Payer: Wise Provider Network Commercial |
$47.97
|
|
|
TRAY LUMBAR PUNCTURE PEDIATRIC
|
Facility
|
OP
|
$51.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$51.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.44
|
| Rate for Payer: Aetna of WY Medicare |
$33.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.41
|
| Rate for Payer: Altius Commercial |
$49.41
|
| Rate for Payer: Beech Street Commercial |
$50.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.26
|
| Rate for Payer: Cash Price |
$36.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.93
|
| Rate for Payer: Cigna of WY Commercial |
$50.44
|
| Rate for Payer: Entrust Commercial |
$48.90
|
| Rate for Payer: First Choice Health Commercial |
$48.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.85
|
| Rate for Payer: HealthUtah PPO |
$51.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.93
|
| Rate for Payer: Multiplan Medicare/VA |
$28.36
|
| Rate for Payer: One Health Plan of WY PPO |
$50.44
|
| Rate for Payer: PacificSource Commercial |
$46.32
|
| Rate for Payer: PHCS PPO |
$50.44
|
| Rate for Payer: Three Rivers PPO |
$38.60
|
| Rate for Payer: TriWest Veterans Administration |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$44.78
|
| Rate for Payer: United Healthcare Medicare |
$29.85
|
| Rate for Payer: WINHealth Partners Commercial |
$50.44
|
| Rate for Payer: Wise Provider Network Commercial |
$48.90
|
|
|
TRAY LUMBAR PUNCTURE PEDIATRIC
|
Facility
|
IP
|
$51.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$51.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.41
|
| Rate for Payer: Altius Commercial |
$49.41
|
| Rate for Payer: Beech Street Commercial |
$50.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.26
|
| Rate for Payer: Cash Price |
$36.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.93
|
| Rate for Payer: Cigna of WY Commercial |
$50.44
|
| Rate for Payer: Entrust Commercial |
$48.90
|
| Rate for Payer: First Choice Health Commercial |
$48.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.97
|
| Rate for Payer: HealthUtah PPO |
$51.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.93
|
| Rate for Payer: Multiplan Medicare/VA |
$32.27
|
| Rate for Payer: One Health Plan of WY PPO |
$50.44
|
| Rate for Payer: PacificSource Commercial |
$46.32
|
| Rate for Payer: PHCS PPO |
$50.44
|
| Rate for Payer: Three Rivers PPO |
$38.60
|
| Rate for Payer: TriWest Veterans Administration |
$33.97
|
| Rate for Payer: United Healthcare Commercial |
$44.78
|
| Rate for Payer: United Healthcare Medicare |
$33.97
|
| Rate for Payer: WINHealth Partners Commercial |
$48.90
|
| Rate for Payer: Wise Provider Network Commercial |
$48.90
|
|
|
TRAY PERICARDIO KIT PC801
|
Facility
|
OP
|
$387.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$387.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.98
|
| Rate for Payer: Aetna of WY Medicare |
$255.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$372.22
|
| Rate for Payer: Altius Commercial |
$372.22
|
| Rate for Payer: Beech Street Commercial |
$379.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$318.33
|
| Rate for Payer: Cash Price |
$271.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.10
|
| Rate for Payer: Cigna of WY Commercial |
$379.98
|
| Rate for Payer: Entrust Commercial |
$368.34
|
| Rate for Payer: First Choice Health Commercial |
$368.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.88
|
| Rate for Payer: HealthUtah PPO |
$387.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.10
|
| Rate for Payer: Multiplan Medicare/VA |
$213.64
|
| Rate for Payer: One Health Plan of WY PPO |
$379.98
|
| Rate for Payer: PacificSource Commercial |
$348.96
|
| Rate for Payer: PHCS PPO |
$379.98
|
| Rate for Payer: Three Rivers PPO |
$290.80
|
| Rate for Payer: TriWest Veterans Administration |
$224.88
|
| Rate for Payer: United Healthcare Commercial |
$337.33
|
| Rate for Payer: United Healthcare Medicare |
$224.88
|
| Rate for Payer: WINHealth Partners Commercial |
$379.98
|
| Rate for Payer: Wise Provider Network Commercial |
$368.34
|
|
|
TRAY PERICARDIO KIT PC801
|
Facility
|
IP
|
$387.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.11 |
| Max. Negotiated Rate |
$387.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$372.22
|
| Rate for Payer: Altius Commercial |
$372.22
|
| Rate for Payer: Beech Street Commercial |
$379.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$318.33
|
| Rate for Payer: Cash Price |
$271.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.10
|
| Rate for Payer: Cigna of WY Commercial |
$379.98
|
| Rate for Payer: Entrust Commercial |
$368.34
|
| Rate for Payer: First Choice Health Commercial |
$368.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.90
|
| Rate for Payer: HealthUtah PPO |
$387.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.10
|
| Rate for Payer: Multiplan Medicare/VA |
$243.11
|
| Rate for Payer: One Health Plan of WY PPO |
$379.98
|
| Rate for Payer: PacificSource Commercial |
$348.96
|
| Rate for Payer: PHCS PPO |
$379.98
|
| Rate for Payer: Three Rivers PPO |
$290.80
|
| Rate for Payer: TriWest Veterans Administration |
$255.90
|
| Rate for Payer: United Healthcare Commercial |
$337.33
|
| Rate for Payer: United Healthcare Medicare |
$255.90
|
| Rate for Payer: WINHealth Partners Commercial |
$368.34
|
| Rate for Payer: Wise Provider Network Commercial |
$368.34
|
|
|
TRAY PNEUMOTHORAX W/O VALVE
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$349.44
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.84
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.24
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$228.23
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$240.24
|
| Rate for Payer: United Healthcare Commercial |
$316.68
|
| Rate for Payer: United Healthcare Medicare |
$240.24
|
| Rate for Payer: WINHealth Partners Commercial |
$345.80
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
TRAY PNEUMOTHORAX W/O VALVE
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.56 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$240.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$349.44
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.84
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.12
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$200.56
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.12
|
| Rate for Payer: United Healthcare Commercial |
$316.68
|
| Rate for Payer: United Healthcare Medicare |
$211.12
|
| Rate for Payer: WINHealth Partners Commercial |
$356.72
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
TRAY THORA-PARACENTESIS 10CM 5FR
|
Facility
|
OP
|
$133.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$133.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.09
|
| Rate for Payer: Aetna of WY Medicare |
$88.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.42
|
| Rate for Payer: Altius Commercial |
$128.42
|
| Rate for Payer: Beech Street Commercial |
$131.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.83
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.76
|
| Rate for Payer: Cigna of WY Commercial |
$131.09
|
| Rate for Payer: Entrust Commercial |
$127.08
|
| Rate for Payer: First Choice Health Commercial |
$127.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.59
|
| Rate for Payer: HealthUtah PPO |
$133.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.76
|
| Rate for Payer: Multiplan Medicare/VA |
$73.71
|
| Rate for Payer: One Health Plan of WY PPO |
$131.09
|
| Rate for Payer: PacificSource Commercial |
$120.39
|
| Rate for Payer: PHCS PPO |
$131.09
|
| Rate for Payer: Three Rivers PPO |
$100.33
|
| Rate for Payer: TriWest Veterans Administration |
$77.59
|
| Rate for Payer: United Healthcare Commercial |
$116.38
|
| Rate for Payer: United Healthcare Medicare |
$77.59
|
| Rate for Payer: WINHealth Partners Commercial |
$131.09
|
| Rate for Payer: Wise Provider Network Commercial |
$127.08
|
|
|
TRAY THORA-PARACENTESIS 10CM 5FR
|
Facility
|
IP
|
$133.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$133.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.42
|
| Rate for Payer: Altius Commercial |
$128.42
|
| Rate for Payer: Beech Street Commercial |
$131.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.83
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.76
|
| Rate for Payer: Cigna of WY Commercial |
$131.09
|
| Rate for Payer: Entrust Commercial |
$127.08
|
| Rate for Payer: First Choice Health Commercial |
$127.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.29
|
| Rate for Payer: HealthUtah PPO |
$133.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.76
|
| Rate for Payer: Multiplan Medicare/VA |
$83.87
|
| Rate for Payer: One Health Plan of WY PPO |
$131.09
|
| Rate for Payer: PacificSource Commercial |
$120.39
|
| Rate for Payer: PHCS PPO |
$131.09
|
| Rate for Payer: Three Rivers PPO |
$100.33
|
| Rate for Payer: TriWest Veterans Administration |
$88.29
|
| Rate for Payer: United Healthcare Commercial |
$116.38
|
| Rate for Payer: United Healthcare Medicare |
$88.29
|
| Rate for Payer: WINHealth Partners Commercial |
$127.08
|
| Rate for Payer: Wise Provider Network Commercial |
$127.08
|
|
