|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
IP
|
$96.47
|
|
|
Service Code
|
NDC 0527197174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.61
|
| Rate for Payer: Altius Commercial |
$92.61
|
| Rate for Payer: Beech Street Commercial |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.20
|
| Rate for Payer: Cash Price |
$67.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.58
|
| Rate for Payer: Cigna of WY Commercial |
$94.54
|
| Rate for Payer: Entrust Commercial |
$91.65
|
| Rate for Payer: First Choice Health Commercial |
$91.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.67
|
| Rate for Payer: HealthUtah PPO |
$96.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.58
|
| Rate for Payer: Multiplan Medicare/VA |
$60.49
|
| Rate for Payer: One Health Plan of WY PPO |
$94.54
|
| Rate for Payer: PacificSource Commercial |
$86.82
|
| Rate for Payer: PHCS PPO |
$94.54
|
| Rate for Payer: Three Rivers PPO |
$72.35
|
| Rate for Payer: TriWest Veterans Administration |
$63.67
|
| Rate for Payer: United Healthcare Commercial |
$83.93
|
| Rate for Payer: United Healthcare Medicare |
$63.67
|
| Rate for Payer: WINHealth Partners Commercial |
$91.65
|
| Rate for Payer: Wise Provider Network Commercial |
$91.65
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
IP
|
$157.06
|
|
|
Service Code
|
NDC 8166530102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.48 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$150.78
|
| Rate for Payer: Altius Commercial |
$150.78
|
| Rate for Payer: Beech Street Commercial |
$153.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.95
|
| Rate for Payer: Cash Price |
$109.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.35
|
| Rate for Payer: Cigna of WY Commercial |
$153.92
|
| Rate for Payer: Entrust Commercial |
$149.21
|
| Rate for Payer: First Choice Health Commercial |
$149.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.66
|
| Rate for Payer: HealthUtah PPO |
$157.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.35
|
| Rate for Payer: Multiplan Medicare/VA |
$98.48
|
| Rate for Payer: One Health Plan of WY PPO |
$153.92
|
| Rate for Payer: PacificSource Commercial |
$141.35
|
| Rate for Payer: PHCS PPO |
$153.92
|
| Rate for Payer: Three Rivers PPO |
$117.80
|
| Rate for Payer: TriWest Veterans Administration |
$103.66
|
| Rate for Payer: United Healthcare Commercial |
$136.64
|
| Rate for Payer: United Healthcare Medicare |
$103.66
|
| Rate for Payer: WINHealth Partners Commercial |
$149.21
|
| Rate for Payer: Wise Provider Network Commercial |
$149.21
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
OP
|
$157.06
|
|
|
Service Code
|
NDC 8166530102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.54 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.92
|
| Rate for Payer: Aetna of WY Medicare |
$103.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$150.78
|
| Rate for Payer: Altius Commercial |
$150.78
|
| Rate for Payer: Beech Street Commercial |
$153.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.95
|
| Rate for Payer: Cash Price |
$109.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.35
|
| Rate for Payer: Cigna of WY Commercial |
$153.92
|
| Rate for Payer: Entrust Commercial |
$149.21
|
| Rate for Payer: First Choice Health Commercial |
$149.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.09
|
| Rate for Payer: HealthUtah PPO |
$157.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.35
|
| Rate for Payer: Multiplan Medicare/VA |
$86.54
|
| Rate for Payer: One Health Plan of WY PPO |
$153.92
|
| Rate for Payer: PacificSource Commercial |
$141.35
|
| Rate for Payer: PHCS PPO |
$153.92
|
| Rate for Payer: Three Rivers PPO |
$117.80
|
| Rate for Payer: TriWest Veterans Administration |
$91.09
|
| Rate for Payer: United Healthcare Commercial |
$136.64
|
| Rate for Payer: United Healthcare Medicare |
$91.09
|
| Rate for Payer: WINHealth Partners Commercial |
$153.92
|
| Rate for Payer: Wise Provider Network Commercial |
$149.21
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 9991605701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| 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 |
$0.15
|
| 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 |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 9991605701
|
|
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 |
$0.15
|
| 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
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 0121077504
|
|
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 |
$0.15
|
| 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
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0121077504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| 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 |
$0.15
|
| 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 |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| 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 |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 94729 26
|
| Hospital Charge Code |
94729
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$8.43
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.43
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$7.17
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.43
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$8.43
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
|
|
CODMAN SURGERY PATTIE .5"X3"
|
Facility
|
IP
|
$18.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.62
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.11
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Multiplan Medicare/VA |
$11.51
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Medicare |
$12.11
|
| Rate for Payer: WINHealth Partners Commercial |
$17.43
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
|
|
CODMAN SURGERY PATTIE .5"X3"
|
Facility
|
OP
|
$18.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Aetna of WY Medicare |
$12.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.62
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.64
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.11
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.64
|
| Rate for Payer: United Healthcare Commercial |
$15.96
|
| Rate for Payer: United Healthcare Medicare |
$10.64
|
| Rate for Payer: WINHealth Partners Commercial |
$17.98
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
|
|
CODMAN SURGERY PATTIE .5"X.5"
|
Facility
|
OP
|
$17.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Medicare |
$11.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.19
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.68
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.19
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$10.19
|
| Rate for Payer: WINHealth Partners Commercial |
$17.22
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
CODMAN SURGERY PATTIE .5"X.5"
|
Facility
|
IP
|
$17.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.69
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
CODMAN SURGERY PATTIE .75X.75"
|
Facility
|
OP
|
$1.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CODMAN SURGERY PATTIE .75X.75"
|
Facility
|
IP
|
$1.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$30.20
|
|
|
Service Code
|
NDC 6068738921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Aetna of WY Medicare |
$19.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.52
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$16.64
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$17.52
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$17.52
|
| Rate for Payer: WINHealth Partners Commercial |
$29.60
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$30.20
|
|
|
Service Code
|
NDC 6068738911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.93
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$18.94
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$19.93
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$19.93
|
| Rate for Payer: WINHealth Partners Commercial |
$28.69
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$30.20
|
|
|
Service Code
|
NDC 6068738911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Aetna of WY Medicare |
$19.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.52
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$16.64
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$17.52
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$17.52
|
| Rate for Payer: WINHealth Partners Commercial |
$29.60
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 3172289901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.79
|
| Rate for Payer: Altius Commercial |
$0.79
|
| Rate for Payer: Beech Street Commercial |
$0.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.80
|
| Rate for Payer: Cigna of WY Commercial |
$0.80
|
| Rate for Payer: Entrust Commercial |
$0.78
|
| Rate for Payer: First Choice Health Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.54
|
| Rate for Payer: HealthUtah PPO |
$0.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.80
|
| Rate for Payer: Multiplan Medicare/VA |
$0.51
|
| Rate for Payer: One Health Plan of WY PPO |
$0.80
|
| Rate for Payer: PacificSource Commercial |
$0.74
|
| Rate for Payer: PHCS PPO |
$0.80
|
| Rate for Payer: Three Rivers PPO |
$0.62
|
| Rate for Payer: TriWest Veterans Administration |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.71
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.78
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$30.20
|
|
|
Service Code
|
NDC 4229205401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.93
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$18.94
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$19.93
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$19.93
|
| Rate for Payer: WINHealth Partners Commercial |
$28.69
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$30.20
|
|
|
Service Code
|
NDC 4229205401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Aetna of WY Medicare |
$19.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.52
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$16.64
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$17.52
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$17.52
|
| Rate for Payer: WINHealth Partners Commercial |
$29.60
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 3172289901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.80
|
| Rate for Payer: Aetna of WY Medicare |
$0.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.79
|
| Rate for Payer: Altius Commercial |
$0.79
|
| Rate for Payer: Beech Street Commercial |
$0.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.80
|
| Rate for Payer: Cigna of WY Commercial |
$0.80
|
| Rate for Payer: Entrust Commercial |
$0.78
|
| Rate for Payer: First Choice Health Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.80
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.80
|
| Rate for Payer: PacificSource Commercial |
$0.74
|
| Rate for Payer: PHCS PPO |
$0.80
|
| Rate for Payer: Three Rivers PPO |
$0.62
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.71
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.80
|
| Rate for Payer: Wise Provider Network Commercial |
$0.78
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$30.20
|
|
|
Service Code
|
NDC 6068738921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.99
|
| Rate for Payer: Altius Commercial |
$28.99
|
| Rate for Payer: Beech Street Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.79
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.29
|
| Rate for Payer: Cigna of WY Commercial |
$29.60
|
| Rate for Payer: Entrust Commercial |
$28.69
|
| Rate for Payer: First Choice Health Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.93
|
| Rate for Payer: HealthUtah PPO |
$30.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.29
|
| Rate for Payer: Multiplan Medicare/VA |
$18.94
|
| Rate for Payer: One Health Plan of WY PPO |
$29.60
|
| Rate for Payer: PacificSource Commercial |
$27.18
|
| Rate for Payer: PHCS PPO |
$29.60
|
| Rate for Payer: Three Rivers PPO |
$22.65
|
| Rate for Payer: TriWest Veterans Administration |
$19.93
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$19.93
|
| Rate for Payer: WINHealth Partners Commercial |
$28.69
|
| Rate for Payer: Wise Provider Network Commercial |
$28.69
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$9,645.00
|
|
|
Service Code
|
HCPCS 44150 AS
|
| Hospital Charge Code |
44150
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$9,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,452.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,752.58
|
| Rate for Payer: Beech Street Commercial |
$9,162.75
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,355.65
|
| Rate for Payer: Cigna of WY Commercial |
$9,452.10
|
| Rate for Payer: First Choice Health Commercial |
$8,680.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,162.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,752.58
|
| Rate for Payer: HealthUtah PPO |
$9,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,355.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,489.69
|
| Rate for Payer: One Health Plan of WY PPO |
$9,452.10
|
| Rate for Payer: PacificSource Commercial |
$8,680.50
|
| Rate for Payer: PHCS PPO |
$9,162.75
|
| Rate for Payer: Three Rivers PPO |
$7,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,752.58
|
| Rate for Payer: United Healthcare Commercial |
$8,391.15
|
| Rate for Payer: United Healthcare Medicare |
$1,752.58
|
| Rate for Payer: WINHealth Partners Commercial |
$8,198.25
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$9,645.00
|
|
|
Service Code
|
HCPCS 44150 80
|
| Hospital Charge Code |
44150
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$9,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,452.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,752.58
|
| Rate for Payer: Beech Street Commercial |
$9,162.75
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,355.65
|
| Rate for Payer: Cigna of WY Commercial |
$9,452.10
|
| Rate for Payer: First Choice Health Commercial |
$8,680.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,162.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,752.58
|
| Rate for Payer: HealthUtah PPO |
$9,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,355.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,489.69
|
| Rate for Payer: One Health Plan of WY PPO |
$9,452.10
|
| Rate for Payer: PacificSource Commercial |
$8,680.50
|
| Rate for Payer: PHCS PPO |
$9,162.75
|
| Rate for Payer: Three Rivers PPO |
$7,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,752.58
|
| Rate for Payer: United Healthcare Commercial |
$8,391.15
|
| Rate for Payer: United Healthcare Medicare |
$1,752.58
|
| Rate for Payer: WINHealth Partners Commercial |
$8,198.25
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$9,645.00
|
|
|
Service Code
|
HCPCS 44150
|
| Hospital Charge Code |
44150
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$9,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,452.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,752.58
|
| Rate for Payer: Beech Street Commercial |
$9,162.75
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: Cash Price |
$6,751.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,355.65
|
| Rate for Payer: Cigna of WY Commercial |
$9,452.10
|
| Rate for Payer: First Choice Health Commercial |
$8,680.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,162.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,752.58
|
| Rate for Payer: HealthUtah PPO |
$9,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,355.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,489.69
|
| Rate for Payer: One Health Plan of WY PPO |
$9,452.10
|
| Rate for Payer: PacificSource Commercial |
$8,680.50
|
| Rate for Payer: PHCS PPO |
$9,162.75
|
| Rate for Payer: Three Rivers PPO |
$7,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,752.58
|
| Rate for Payer: United Healthcare Commercial |
$8,391.15
|
| Rate for Payer: United Healthcare Medicare |
$1,752.58
|
| Rate for Payer: WINHealth Partners Commercial |
$8,198.25
|
|
