|
EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$111.94 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,281.84
|
| Rate for Payer: Aetna of WY Medicare |
$131.69
|
| Rate for Payer: Beech Street Commercial |
$1,242.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: Cash Price |
$915.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,268.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,281.84
|
| Rate for Payer: First Choice Health Commercial |
$1,177.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,242.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.69
|
| Rate for Payer: HealthUtah PPO |
$1,308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,268.76
|
| Rate for Payer: Multiplan Medicare/VA |
$111.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,281.84
|
| Rate for Payer: PacificSource Commercial |
$1,177.20
|
| Rate for Payer: PHCS PPO |
$1,242.60
|
| Rate for Payer: Three Rivers PPO |
$981.00
|
| Rate for Payer: TriWest Veterans Administration |
$131.69
|
| Rate for Payer: United Healthcare Commercial |
$1,137.96
|
| Rate for Payer: United Healthcare Medicare |
$131.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,111.80
|
|
|
EGD WIRE GUIDED BALLOON 13.5-15.5MM
|
Facility
|
OP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.34 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Aetna of WY Medicare |
$408.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.31
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$341.34
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$359.31
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$359.31
|
| Rate for Payer: WINHealth Partners Commercial |
$607.11
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EGD WIRE GUIDED BALLOON 13.5-15.5MM
|
Facility
|
IP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.43 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.87
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$388.43
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$408.87
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$408.87
|
| Rate for Payer: WINHealth Partners Commercial |
$588.52
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EGD WIRE GUIDED BALLOON 16-18MM
|
Facility
|
IP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.43 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.87
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$388.43
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$408.87
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$408.87
|
| Rate for Payer: WINHealth Partners Commercial |
$588.52
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EGD WIRE GUIDED BALLOON 16-18MM
|
Facility
|
OP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.34 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Aetna of WY Medicare |
$408.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.31
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$341.34
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$359.31
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$359.31
|
| Rate for Payer: WINHealth Partners Commercial |
$607.11
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EGD WIRE GUIDED BALLOON 18-20MM
|
Facility
|
OP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.34 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Aetna of WY Medicare |
$408.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.31
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$341.34
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$359.31
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$359.31
|
| Rate for Payer: WINHealth Partners Commercial |
$607.11
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EGD WIRE GUIDED BALLOON 18-20MM
|
Facility
|
IP
|
$619.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.43 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$594.72
|
| Rate for Payer: Altius Commercial |
$594.72
|
| Rate for Payer: Beech Street Commercial |
$607.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$508.61
|
| Rate for Payer: Cash Price |
$433.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.92
|
| Rate for Payer: Cigna of WY Commercial |
$607.11
|
| Rate for Payer: Entrust Commercial |
$588.52
|
| Rate for Payer: First Choice Health Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.87
|
| Rate for Payer: HealthUtah PPO |
$619.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.92
|
| Rate for Payer: Multiplan Medicare/VA |
$388.43
|
| Rate for Payer: One Health Plan of WY PPO |
$607.11
|
| Rate for Payer: PacificSource Commercial |
$557.55
|
| Rate for Payer: PHCS PPO |
$607.11
|
| Rate for Payer: Three Rivers PPO |
$464.62
|
| Rate for Payer: TriWest Veterans Administration |
$408.87
|
| Rate for Payer: United Healthcare Commercial |
$538.96
|
| Rate for Payer: United Healthcare Medicare |
$408.87
|
| Rate for Payer: WINHealth Partners Commercial |
$588.52
|
| Rate for Payer: Wise Provider Network Commercial |
$588.52
|
|
|
EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS G0403
|
| Hospital Charge Code |
G0403
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$13.91
|
| Rate for Payer: Beech Street Commercial |
$151.05
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: First Choice Health Commercial |
$143.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.91
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$11.82
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$151.05
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.91
|
| Rate for Payer: United Healthcare Commercial |
$138.33
|
| Rate for Payer: United Healthcare Medicare |
$13.91
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
|
|
EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS G0405
|
| Hospital Charge Code |
G0405
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Beech Street Commercial |
$60.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: First Choice Health Commercial |
$57.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$60.80
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: WINHealth Partners Commercial |
$60.80
|
|
|
EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
G0404
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$135.85
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: First Choice Health Commercial |
$128.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$5.22
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$135.85
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
| Rate for Payer: WINHealth Partners Commercial |
$135.85
|
|
|
ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS A4466
|
| Hospital Charge Code |
A4466
|
| Min. Negotiated Rate |
$81.75 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Beech Street Commercial |
$103.55
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: First Choice Health Commercial |
$98.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$103.55
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
|
|
ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
95972
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,054.48
|
| Rate for Payer: Aetna of WY Medicare |
$38.28
|
| Rate for Payer: Beech Street Commercial |
$1,022.20
|
| Rate for Payer: Cash Price |
$753.20
|
| Rate for Payer: Cash Price |
$753.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,043.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,054.48
|
| Rate for Payer: First Choice Health Commercial |
$968.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,022.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$1,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,043.72
|
| Rate for Payer: Multiplan Medicare/VA |
$32.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,054.48
|
| Rate for Payer: PacificSource Commercial |
$968.40
|
| Rate for Payer: PHCS PPO |
$1,022.20
|
| Rate for Payer: Three Rivers PPO |
$807.00
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$936.12
|
| Rate for Payer: United Healthcare Medicare |
$38.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,022.20
|
|
|
ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
G0283
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$87.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: First Choice Health Commercial |
$82.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$87.40
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$80.04
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
|
|
ELECTRODE LEEP LOOP 2CM X 2CM
|
Facility
|
IP
|
$92.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.74
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.89
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.01
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$57.96
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$61.01
|
| Rate for Payer: United Healthcare Commercial |
$80.42
|
| Rate for Payer: United Healthcare Medicare |
$61.01
|
| Rate for Payer: WINHealth Partners Commercial |
$87.82
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
|
ELECTRODE LEEP LOOP 2CM X 2CM
|
Facility
|
OP
|
$92.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Aetna of WY Medicare |
$61.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.74
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.89
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.62
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$50.93
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$53.62
|
| Rate for Payer: United Healthcare Commercial |
$80.42
|
| Rate for Payer: United Healthcare Medicare |
$53.62
|
| Rate for Payer: WINHealth Partners Commercial |
$90.59
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
|
ELECTRODE REM POLYHESIVE ADULT PATIENT RETURN 9'
|
Facility
|
OP
|
$9.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.43
|
| Rate for Payer: Aetna of WY Medicare |
$6.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.24
|
| Rate for Payer: Altius Commercial |
$9.24
|
| Rate for Payer: Beech Street Commercial |
$9.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.90
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.33
|
| Rate for Payer: Cigna of WY Commercial |
$9.43
|
| Rate for Payer: Entrust Commercial |
$9.14
|
| Rate for Payer: First Choice Health Commercial |
$9.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.58
|
| Rate for Payer: HealthUtah PPO |
$9.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.33
|
| Rate for Payer: Multiplan Medicare/VA |
$5.30
|
| Rate for Payer: One Health Plan of WY PPO |
$9.43
|
| Rate for Payer: PacificSource Commercial |
$8.66
|
| Rate for Payer: PHCS PPO |
$9.43
|
| Rate for Payer: Three Rivers PPO |
$7.22
|
| Rate for Payer: TriWest Veterans Administration |
$5.58
|
| Rate for Payer: United Healthcare Commercial |
$8.37
|
| Rate for Payer: United Healthcare Medicare |
$5.58
|
| Rate for Payer: WINHealth Partners Commercial |
$9.43
|
| Rate for Payer: Wise Provider Network Commercial |
$9.14
|
|
|
ELECTRODE REM POLYHESIVE ADULT PATIENT RETURN 9'
|
Facility
|
IP
|
$9.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.24
|
| Rate for Payer: Altius Commercial |
$9.24
|
| Rate for Payer: Beech Street Commercial |
$9.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.90
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.33
|
| Rate for Payer: Cigna of WY Commercial |
$9.43
|
| Rate for Payer: Entrust Commercial |
$9.14
|
| Rate for Payer: First Choice Health Commercial |
$9.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.35
|
| Rate for Payer: HealthUtah PPO |
$9.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.33
|
| Rate for Payer: Multiplan Medicare/VA |
$6.03
|
| Rate for Payer: One Health Plan of WY PPO |
$9.43
|
| Rate for Payer: PacificSource Commercial |
$8.66
|
| Rate for Payer: PHCS PPO |
$9.43
|
| Rate for Payer: Three Rivers PPO |
$7.22
|
| Rate for Payer: TriWest Veterans Administration |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$8.37
|
| Rate for Payer: United Healthcare Medicare |
$6.35
|
| Rate for Payer: WINHealth Partners Commercial |
$9.14
|
| Rate for Payer: Wise Provider Network Commercial |
$9.14
|
|
|
ELECTROLYTE PANEL
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
80051
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$7.01
|
| Rate for Payer: Beech Street Commercial |
$90.25
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.01
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$5.96
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$90.25
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.01
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$7.01
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
|
|
ELECTROLYTE-S IVPB BOLUS (ISOLYTE) [4090000075]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
ELECTROLYTE-S IVPB BOLUS (ISOLYTE) [4090000075]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
ELECTROLYTE-S (PH 7.4) INTRAVENOUS SOLUTION [2756]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
ELECTROLYTE-S (PH 7.4) INTRAVENOUS SOLUTION [2756]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.43
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99318
|
| Hospital Charge Code |
99318
|
| Min. Negotiated Rate |
$180.75 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: First Choice Health Commercial |
$216.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
|
|
EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
HCPCS 34111
|
| Hospital Charge Code |
34111
|
| Min. Negotiated Rate |
$466.83 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,920.80
|
| Rate for Payer: Aetna of WY Medicare |
$549.21
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,901.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,920.80
|
| Rate for Payer: First Choice Health Commercial |
$1,764.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,862.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.21
|
| Rate for Payer: HealthUtah PPO |
$1,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,901.20
|
| Rate for Payer: Multiplan Medicare/VA |
$466.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,920.80
|
| Rate for Payer: PacificSource Commercial |
$1,764.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,470.00
|
| Rate for Payer: TriWest Veterans Administration |
$549.21
|
| Rate for Payer: United Healthcare Commercial |
$1,705.20
|
| Rate for Payer: United Healthcare Medicare |
$549.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,666.00
|
|
|
EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
HCPCS 34111 AS
|
| Hospital Charge Code |
34111
|
| Min. Negotiated Rate |
$466.83 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,920.80
|
| Rate for Payer: Aetna of WY Medicare |
$549.21
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,901.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,920.80
|
| Rate for Payer: First Choice Health Commercial |
$1,764.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,862.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.21
|
| Rate for Payer: HealthUtah PPO |
$1,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,901.20
|
| Rate for Payer: Multiplan Medicare/VA |
$466.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,920.80
|
| Rate for Payer: PacificSource Commercial |
$1,764.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,470.00
|
| Rate for Payer: TriWest Veterans Administration |
$549.21
|
| Rate for Payer: United Healthcare Commercial |
$1,705.20
|
| Rate for Payer: United Healthcare Medicare |
$549.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,666.00
|
|
