|
COVER CAMERA STERIS
|
Facility
|
IP
|
$15.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
COVER CAMERA STERIS
|
Facility
|
OP
|
$15.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.42
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.71
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$13.07
|
| Rate for Payer: United Healthcare Medicare |
$8.71
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
COVID-19 LAB TEST NON-CDC
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
U0002
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$51.31
|
| Rate for Payer: Beech Street Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: First Choice Health Commercial |
$181.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.31
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$43.61
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$191.90
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$51.31
|
| Rate for Payer: United Healthcare Commercial |
$175.74
|
| Rate for Payer: United Healthcare Medicare |
$51.31
|
| Rate for Payer: WINHealth Partners Commercial |
$191.90
|
|
|
COVID-19 VACC,BV(ORIG,BA.4/5)(MODERNA)(PF) 50 MCG/0.5 ML IM SUSP (EUA) [176928]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
HCPCS 91313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
COVID-19 VACC,BV(ORIG,BA.4/5)(MODERNA)(PF) 50 MCG/0.5 ML IM SUSP (EUA) [176928]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
HCPCS 91313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
COVID-19 VACCINE,MRNA,CX024414(MODERNA)(PF)100 MCG/0.5 ML IM SUSP [160551]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 8077727310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
COVID-19 VACCINE,MRNA,CX024414(MODERNA)(PF)100 MCG/0.5 ML IM SUSP [160551]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 8077727310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
NDC 8077710204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.79 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$126.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.32
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.63
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.36
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$105.79
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$111.36
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: United Healthcare Medicare |
$111.36
|
| Rate for Payer: WINHealth Partners Commercial |
$188.16
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
NDC 8077710295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$200.64
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.20
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$211.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
NDC 8077710295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.60
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$176.32
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.60
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$185.60
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
NDC 8077710204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$184.32
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.63
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.72
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$120.38
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$126.72
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: United Healthcare Medicare |
$126.72
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
COVID VAC 2023-24 (12 YR UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SYRINGE [183899]
|
Facility
|
IP
|
$338.75
|
|
|
Service Code
|
HCPCS 91322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.40 |
| Max. Negotiated Rate |
$338.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$325.20
|
| Rate for Payer: Altius Commercial |
$325.20
|
| Rate for Payer: Beech Street Commercial |
$331.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.11
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.59
|
| Rate for Payer: Cigna of WY Commercial |
$331.98
|
| Rate for Payer: Entrust Commercial |
$321.81
|
| Rate for Payer: First Choice Health Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.58
|
| Rate for Payer: HealthUtah PPO |
$338.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.59
|
| Rate for Payer: Multiplan Medicare/VA |
$212.40
|
| Rate for Payer: One Health Plan of WY PPO |
$331.98
|
| Rate for Payer: PacificSource Commercial |
$304.88
|
| Rate for Payer: PHCS PPO |
$331.98
|
| Rate for Payer: Three Rivers PPO |
$254.06
|
| Rate for Payer: TriWest Veterans Administration |
$223.58
|
| Rate for Payer: United Healthcare Commercial |
$294.71
|
| Rate for Payer: United Healthcare Medicare |
$223.58
|
| Rate for Payer: WINHealth Partners Commercial |
$321.81
|
| Rate for Payer: Wise Provider Network Commercial |
$321.81
|
|
|
COVID VAC 2023-24 (12 YR UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SYRINGE [183899]
|
Facility
|
OP
|
$338.75
|
|
|
Service Code
|
HCPCS 91322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.65 |
| Max. Negotiated Rate |
$338.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.98
|
| Rate for Payer: Aetna of WY Medicare |
$223.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$325.20
|
| Rate for Payer: Altius Commercial |
$325.20
|
| Rate for Payer: Beech Street Commercial |
$331.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.11
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.59
|
| Rate for Payer: Cigna of WY Commercial |
$331.98
|
| Rate for Payer: Entrust Commercial |
$321.81
|
| Rate for Payer: First Choice Health Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.48
|
| Rate for Payer: HealthUtah PPO |
$338.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.59
|
| Rate for Payer: Multiplan Medicare/VA |
$186.65
|
| Rate for Payer: One Health Plan of WY PPO |
$331.98
|
| Rate for Payer: PacificSource Commercial |
$304.88
|
| Rate for Payer: PHCS PPO |
$331.98
|
| Rate for Payer: Three Rivers PPO |
$254.06
|
| Rate for Payer: TriWest Veterans Administration |
$196.48
|
| Rate for Payer: United Healthcare Commercial |
$294.71
|
| Rate for Payer: United Healthcare Medicare |
$196.48
|
| Rate for Payer: WINHealth Partners Commercial |
$331.98
|
| Rate for Payer: Wise Provider Network Commercial |
$321.81
|
|
|
COVID VACC 2024-25 (12 YRS UP) (MODERNA)(PF) 50 MCG/0.5 ML IM SYRINGE [187970]
|
Facility
|
OP
|
$369.50
|
|
|
Service Code
|
HCPCS 91322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.59 |
| Max. Negotiated Rate |
$369.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.11
|
| Rate for Payer: Aetna of WY Medicare |
$243.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$354.72
|
| Rate for Payer: Altius Commercial |
$354.72
|
| Rate for Payer: Beech Street Commercial |
$362.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.36
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.42
|
| Rate for Payer: Cigna of WY Commercial |
$362.11
|
| Rate for Payer: Entrust Commercial |
$351.02
|
| Rate for Payer: First Choice Health Commercial |
$351.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.31
|
| Rate for Payer: HealthUtah PPO |
$369.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.42
|
| Rate for Payer: Multiplan Medicare/VA |
$203.59
|
| Rate for Payer: One Health Plan of WY PPO |
$362.11
|
| Rate for Payer: PacificSource Commercial |
$332.55
|
| Rate for Payer: PHCS PPO |
$362.11
|
| Rate for Payer: Three Rivers PPO |
$277.12
|
| Rate for Payer: TriWest Veterans Administration |
$214.31
|
| Rate for Payer: United Healthcare Commercial |
$321.46
|
| Rate for Payer: United Healthcare Medicare |
$214.31
|
| Rate for Payer: WINHealth Partners Commercial |
$362.11
|
| Rate for Payer: Wise Provider Network Commercial |
$351.02
|
|
|
COVID VACC 2024-25 (12 YRS UP) (MODERNA)(PF) 50 MCG/0.5 ML IM SYRINGE [187970]
|
Facility
|
IP
|
$369.50
|
|
|
Service Code
|
HCPCS 91322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$231.68 |
| Max. Negotiated Rate |
$369.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$354.72
|
| Rate for Payer: Altius Commercial |
$354.72
|
| Rate for Payer: Beech Street Commercial |
$362.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.36
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.42
|
| Rate for Payer: Cigna of WY Commercial |
$362.11
|
| Rate for Payer: Entrust Commercial |
$351.02
|
| Rate for Payer: First Choice Health Commercial |
$351.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.87
|
| Rate for Payer: HealthUtah PPO |
$369.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.42
|
| Rate for Payer: Multiplan Medicare/VA |
$231.68
|
| Rate for Payer: One Health Plan of WY PPO |
$362.11
|
| Rate for Payer: PacificSource Commercial |
$332.55
|
| Rate for Payer: PHCS PPO |
$362.11
|
| Rate for Payer: Three Rivers PPO |
$277.12
|
| Rate for Payer: TriWest Veterans Administration |
$243.87
|
| Rate for Payer: United Healthcare Commercial |
$321.46
|
| Rate for Payer: United Healthcare Medicare |
$243.87
|
| Rate for Payer: WINHealth Partners Commercial |
$351.02
|
| Rate for Payer: Wise Provider Network Commercial |
$351.02
|
|
|
CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 99489
|
| Hospital Charge Code |
99489
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$111.15
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: First Choice Health Commercial |
$105.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$111.15
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$111.15
|
|
|
CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 20985 AS
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$136.44
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.44
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Multiplan Medicare/VA |
$115.97
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$136.44
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 20985 80
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$136.44
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.44
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Multiplan Medicare/VA |
$115.97
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$136.44
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
20985
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$740.88
|
| Rate for Payer: Aetna of WY Medicare |
$136.44
|
| Rate for Payer: Beech Street Commercial |
$718.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$733.32
|
| Rate for Payer: Cigna of WY Commercial |
$740.88
|
| Rate for Payer: First Choice Health Commercial |
$680.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$718.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.44
|
| Rate for Payer: HealthUtah PPO |
$756.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$733.32
|
| Rate for Payer: Multiplan Medicare/VA |
$115.97
|
| Rate for Payer: One Health Plan of WY PPO |
$740.88
|
| Rate for Payer: PacificSource Commercial |
$680.40
|
| Rate for Payer: PHCS PPO |
$718.20
|
| Rate for Payer: Three Rivers PPO |
$567.00
|
| Rate for Payer: TriWest Veterans Administration |
$136.44
|
| Rate for Payer: United Healthcare Commercial |
$657.72
|
| Rate for Payer: United Healthcare Medicare |
$136.44
|
| Rate for Payer: WINHealth Partners Commercial |
$642.60
|
|
|
CRANBERRY EXTRACT-VITAMIN C 250 MG-60 MG CAPSULE [97773]
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
NDC 5042854229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.42
|
| Rate for Payer: Aetna of WY Medicare |
$0.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.41
|
| Rate for Payer: Altius Commercial |
$0.41
|
| Rate for Payer: Beech Street Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.42
|
| Rate for Payer: Cigna of WY Commercial |
$0.42
|
| Rate for Payer: Entrust Commercial |
$0.41
|
| Rate for Payer: First Choice Health Commercial |
$0.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.25
|
| Rate for Payer: HealthUtah PPO |
$0.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.42
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.42
|
| Rate for Payer: PacificSource Commercial |
$0.39
|
| Rate for Payer: PHCS PPO |
$0.42
|
| Rate for Payer: Three Rivers PPO |
$0.32
|
| Rate for Payer: TriWest Veterans Administration |
$0.25
|
| Rate for Payer: United Healthcare Commercial |
$0.37
|
| Rate for Payer: United Healthcare Medicare |
$0.25
|
| Rate for Payer: WINHealth Partners Commercial |
$0.42
|
| Rate for Payer: Wise Provider Network Commercial |
$0.41
|
|
|
CRANBERRY EXTRACT-VITAMIN C 250 MG-60 MG CAPSULE [97773]
|
Facility
|
IP
|
$0.43
|
|
|
Service Code
|
NDC 5042854229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.41
|
| Rate for Payer: Altius Commercial |
$0.41
|
| Rate for Payer: Beech Street Commercial |
$0.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.35
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.42
|
| Rate for Payer: Cigna of WY Commercial |
$0.42
|
| Rate for Payer: Entrust Commercial |
$0.41
|
| Rate for Payer: First Choice Health Commercial |
$0.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.42
|
| Rate for Payer: Multiplan Medicare/VA |
$0.27
|
| Rate for Payer: One Health Plan of WY PPO |
$0.42
|
| Rate for Payer: PacificSource Commercial |
$0.39
|
| Rate for Payer: PHCS PPO |
$0.42
|
| Rate for Payer: Three Rivers PPO |
$0.32
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.37
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.41
|
| Rate for Payer: Wise Provider Network Commercial |
$0.41
|
|
|
CRANBERRY FRUIT 450 MG TABLET [97524]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 5789684501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.13
|
| Rate for Payer: Altius Commercial |
$0.13
|
| Rate for Payer: Beech Street Commercial |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.14
|
| Rate for Payer: Cigna of WY Commercial |
$0.14
|
| Rate for Payer: Entrust Commercial |
$0.13
|
| Rate for Payer: First Choice Health Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.14
|
| Rate for Payer: PacificSource Commercial |
$0.13
|
| Rate for Payer: PHCS PPO |
$0.14
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.13
|
| Rate for Payer: Wise Provider Network Commercial |
$0.13
|
|
|
CRANBERRY FRUIT 450 MG TABLET [97524]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 5789684501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.13
|
| Rate for Payer: Altius Commercial |
$0.13
|
| Rate for Payer: Beech Street Commercial |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.14
|
| Rate for Payer: Cigna of WY Commercial |
$0.14
|
| Rate for Payer: Entrust Commercial |
$0.13
|
| Rate for Payer: First Choice Health Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.08
|
| Rate for Payer: HealthUtah PPO |
$0.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.14
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.14
|
| Rate for Payer: PacificSource Commercial |
$0.13
|
| Rate for Payer: PHCS PPO |
$0.14
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$0.08
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.13
|
|
|
CREATININE BLOOD
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
82565
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$5.12
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.12
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$4.35
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$5.12
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
CRICOPHARYNGEAL MYOTOMY
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 43030
|
| Hospital Charge Code |
43030
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,614.64
|
| Rate for Payer: Aetna of WY Medicare |
$508.40
|
| Rate for Payer: Beech Street Commercial |
$2,534.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: Cash Price |
$1,867.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,587.96
|
| Rate for Payer: Cigna of WY Commercial |
$2,614.64
|
| Rate for Payer: First Choice Health Commercial |
$2,401.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$508.40
|
| Rate for Payer: HealthUtah PPO |
$2,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,587.96
|
| Rate for Payer: Multiplan Medicare/VA |
$432.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,614.64
|
| Rate for Payer: PacificSource Commercial |
$2,401.20
|
| Rate for Payer: PHCS PPO |
$2,534.60
|
| Rate for Payer: Three Rivers PPO |
$2,001.00
|
| Rate for Payer: TriWest Veterans Administration |
$508.40
|
| Rate for Payer: United Healthcare Commercial |
$2,321.16
|
| Rate for Payer: United Healthcare Medicare |
$508.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,267.80
|
|
