|
HANGING CAST SLING SMALL
|
Facility
|
IP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.30
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$13.58
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING SMALL
|
Facility
|
OP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.56
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.93
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$12.56
|
| Rate for Payer: WINHealth Partners Commercial |
$21.23
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING XLARGE
|
Facility
|
OP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.56
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.93
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$12.56
|
| Rate for Payer: WINHealth Partners Commercial |
$21.23
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING XLARGE
|
Facility
|
IP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.30
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$13.58
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 15040
|
| Hospital Charge Code |
15040
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$613.48
|
| Rate for Payer: Aetna of WY Medicare |
$119.13
|
| Rate for Payer: Beech Street Commercial |
$594.70
|
| Rate for Payer: Cash Price |
$438.20
|
| Rate for Payer: Cash Price |
$438.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$607.22
|
| Rate for Payer: Cigna of WY Commercial |
$613.48
|
| Rate for Payer: First Choice Health Commercial |
$563.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$594.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.13
|
| Rate for Payer: HealthUtah PPO |
$626.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$607.22
|
| Rate for Payer: Multiplan Medicare/VA |
$101.26
|
| Rate for Payer: One Health Plan of WY PPO |
$613.48
|
| Rate for Payer: PacificSource Commercial |
$563.40
|
| Rate for Payer: PHCS PPO |
$594.70
|
| Rate for Payer: Three Rivers PPO |
$469.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.13
|
| Rate for Payer: United Healthcare Commercial |
$544.62
|
| Rate for Payer: United Healthcare Medicare |
$119.13
|
| Rate for Payer: WINHealth Partners Commercial |
$532.10
|
|
|
HB ACETYLCHOLINE RECEPTOR BINDING ANTIBODY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86041
|
| Hospital Charge Code |
3028604101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| 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: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.22
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.06
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$63.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HB ACETYLCHOLINE RECEPTOR BINDING ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86041
|
| Hospital Charge Code |
3028604101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| 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: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.94
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.34
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$71.94
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HB ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86043
|
| Hospital Charge Code |
3028604301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$65.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$97.02
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HB ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86043
|
| Hospital Charge Code |
3028604301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.07 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$95.04
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.28
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.34
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$62.07
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.34
|
| Rate for Payer: United Healthcare Commercial |
$86.13
|
| Rate for Payer: United Healthcare Medicare |
$65.34
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HB PRO REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Facility
|
IP
|
$7,895.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
9832713801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$4,950.16 |
| Max. Negotiated Rate |
$7,895.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,737.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,579.20
|
| Rate for Payer: Altius Commercial |
$7,579.20
|
| Rate for Payer: Beech Street Commercial |
$7,737.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,481.80
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,658.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,737.10
|
| Rate for Payer: Entrust Commercial |
$7,500.25
|
| Rate for Payer: First Choice Health Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,210.70
|
| Rate for Payer: HealthUtah PPO |
$7,895.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,658.15
|
| Rate for Payer: Multiplan Medicare/VA |
$4,950.16
|
| Rate for Payer: One Health Plan of WY PPO |
$7,737.10
|
| Rate for Payer: PacificSource Commercial |
$7,105.50
|
| Rate for Payer: PHCS PPO |
$7,737.10
|
| Rate for Payer: Three Rivers PPO |
$5,921.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,210.70
|
| Rate for Payer: United Healthcare Commercial |
$6,868.65
|
| Rate for Payer: United Healthcare Medicare |
$5,210.70
|
| Rate for Payer: WINHealth Partners Commercial |
$7,500.25
|
| Rate for Payer: Wise Provider Network Commercial |
$7,500.25
|
|
|
HB PRO REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Facility
|
OP
|
$7,895.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
9832713801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$4,350.14 |
| Max. Negotiated Rate |
$7,895.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,737.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,579.20
|
| Rate for Payer: Altius Commercial |
$7,579.20
|
| Rate for Payer: Beech Street Commercial |
$7,737.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,481.80
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,658.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,737.10
|
| Rate for Payer: Entrust Commercial |
$7,500.25
|
| Rate for Payer: First Choice Health Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,579.10
|
| Rate for Payer: HealthUtah PPO |
$7,895.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,658.15
|
| Rate for Payer: Multiplan Medicare/VA |
$4,350.14
|
| Rate for Payer: One Health Plan of WY PPO |
$7,737.10
|
| Rate for Payer: PacificSource Commercial |
$7,105.50
|
| Rate for Payer: PHCS PPO |
$7,737.10
|
| Rate for Payer: Three Rivers PPO |
$5,921.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,579.10
|
| Rate for Payer: United Healthcare Commercial |
$6,868.65
|
| Rate for Payer: United Healthcare Medicare |
$4,579.10
|
| Rate for Payer: WINHealth Partners Commercial |
$7,737.10
|
| Rate for Payer: Wise Provider Network Commercial |
$7,500.25
|
|
|
HB PRO RNSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Facility
|
IP
|
$9,211.00
|
|
|
Service Code
|
HCPCS 30468
|
| Hospital Charge Code |
9753046801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$5,775.30 |
| Max. Negotiated Rate |
$9,211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,026.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,842.56
|
| Rate for Payer: Altius Commercial |
$8,842.56
|
| Rate for Payer: Beech Street Commercial |
$9,026.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,562.23
|
| Rate for Payer: Cash Price |
$6,447.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,934.67
|
| Rate for Payer: Cigna of WY Commercial |
$9,026.78
|
| Rate for Payer: Entrust Commercial |
$8,750.45
|
| Rate for Payer: First Choice Health Commercial |
$8,750.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,750.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,079.26
|
| Rate for Payer: HealthUtah PPO |
$9,211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,934.67
|
| Rate for Payer: Multiplan Medicare/VA |
$5,775.30
|
| Rate for Payer: One Health Plan of WY PPO |
$9,026.78
|
| Rate for Payer: PacificSource Commercial |
$8,289.90
|
| Rate for Payer: PHCS PPO |
$9,026.78
|
| Rate for Payer: Three Rivers PPO |
$6,908.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,079.26
|
| Rate for Payer: United Healthcare Commercial |
$8,013.57
|
| Rate for Payer: United Healthcare Medicare |
$6,079.26
|
| Rate for Payer: WINHealth Partners Commercial |
$8,750.45
|
| Rate for Payer: Wise Provider Network Commercial |
$8,750.45
|
|
|
HB PRO RNSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Facility
|
OP
|
$9,211.00
|
|
|
Service Code
|
HCPCS 30468
|
| Hospital Charge Code |
9753046801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$5,075.26 |
| Max. Negotiated Rate |
$9,211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,026.78
|
| Rate for Payer: Aetna of WY Medicare |
$6,079.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,842.56
|
| Rate for Payer: Altius Commercial |
$8,842.56
|
| Rate for Payer: Beech Street Commercial |
$9,026.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,562.23
|
| Rate for Payer: Cash Price |
$6,447.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,934.67
|
| Rate for Payer: Cigna of WY Commercial |
$9,026.78
|
| Rate for Payer: Entrust Commercial |
$8,750.45
|
| Rate for Payer: First Choice Health Commercial |
$8,750.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,750.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,342.38
|
| Rate for Payer: HealthUtah PPO |
$9,211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,934.67
|
| Rate for Payer: Multiplan Medicare/VA |
$5,075.26
|
| Rate for Payer: One Health Plan of WY PPO |
$9,026.78
|
| Rate for Payer: PacificSource Commercial |
$8,289.90
|
| Rate for Payer: PHCS PPO |
$9,026.78
|
| Rate for Payer: Three Rivers PPO |
$6,908.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,342.38
|
| Rate for Payer: United Healthcare Commercial |
$8,013.57
|
| Rate for Payer: United Healthcare Medicare |
$5,342.38
|
| Rate for Payer: WINHealth Partners Commercial |
$9,026.78
|
| Rate for Payer: Wise Provider Network Commercial |
$8,750.45
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Aetna of WY Medicare |
$432.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.90
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$360.90
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.90
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$379.90
|
| Rate for Payer: WINHealth Partners Commercial |
$641.90
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$410.68 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.30
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$410.68
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$432.30
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$432.30
|
| Rate for Payer: WINHealth Partners Commercial |
$622.25
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637702
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Aetna of WY Medicare |
$432.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.90
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$360.90
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.90
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$379.90
|
| Rate for Payer: WINHealth Partners Commercial |
$641.90
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637702
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$410.68 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.30
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$410.68
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$432.30
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$432.30
|
| Rate for Payer: WINHealth Partners Commercial |
$622.25
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC 4K SCORE PSA KALLIKREIN
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS 81539
|
| Hospital Charge Code |
3108153901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,439.03 |
| Max. Negotiated Rate |
$3,890.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,812.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,734.40
|
| Rate for Payer: Altius Commercial |
$3,734.40
|
| Rate for Payer: Beech Street Commercial |
$3,812.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,193.69
|
| Rate for Payer: Cash Price |
$2,723.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,773.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,812.20
|
| Rate for Payer: Entrust Commercial |
$3,695.50
|
| Rate for Payer: First Choice Health Commercial |
$3,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,567.40
|
| Rate for Payer: HealthUtah PPO |
$3,890.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,773.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2,439.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3,812.20
|
| Rate for Payer: PacificSource Commercial |
$3,501.00
|
| Rate for Payer: PHCS PPO |
$3,812.20
|
| Rate for Payer: Three Rivers PPO |
$2,917.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,567.40
|
| Rate for Payer: United Healthcare Commercial |
$3,384.30
|
| Rate for Payer: United Healthcare Medicare |
$2,567.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,695.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,695.50
|
|
|
HC 4K SCORE PSA KALLIKREIN
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS 81539
|
| Hospital Charge Code |
3108153901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,143.39 |
| Max. Negotiated Rate |
$3,890.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,812.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,567.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,734.40
|
| Rate for Payer: Altius Commercial |
$3,734.40
|
| Rate for Payer: Beech Street Commercial |
$3,812.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,193.69
|
| Rate for Payer: Cash Price |
$2,723.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,773.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,812.20
|
| Rate for Payer: Entrust Commercial |
$3,695.50
|
| Rate for Payer: First Choice Health Commercial |
$3,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,256.20
|
| Rate for Payer: HealthUtah PPO |
$3,890.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,773.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2,143.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,812.20
|
| Rate for Payer: PacificSource Commercial |
$3,501.00
|
| Rate for Payer: PHCS PPO |
$3,812.20
|
| Rate for Payer: Three Rivers PPO |
$2,917.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,256.20
|
| Rate for Payer: United Healthcare Commercial |
$3,384.30
|
| Rate for Payer: United Healthcare Medicare |
$2,256.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,812.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,695.50
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
7614908301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
IP
|
$4,110.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4024908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,576.97 |
| Max. Negotiated Rate |
$4,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,027.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,945.60
|
| Rate for Payer: Altius Commercial |
$3,945.60
|
| Rate for Payer: Beech Street Commercial |
$4,027.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,374.31
|
| Rate for Payer: Cash Price |
$2,877.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,986.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,027.80
|
| Rate for Payer: Entrust Commercial |
$3,904.50
|
| Rate for Payer: First Choice Health Commercial |
$3,904.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,904.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,712.60
|
| Rate for Payer: HealthUtah PPO |
$4,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,986.70
|
| Rate for Payer: Multiplan Medicare/VA |
$2,576.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4,027.80
|
| Rate for Payer: PacificSource Commercial |
$3,699.00
|
| Rate for Payer: PHCS PPO |
$4,027.80
|
| Rate for Payer: Three Rivers PPO |
$3,082.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,712.60
|
| Rate for Payer: United Healthcare Commercial |
$3,575.70
|
| Rate for Payer: United Healthcare Medicare |
$2,712.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,904.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,904.50
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
OP
|
$4,110.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4024908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,264.61 |
| Max. Negotiated Rate |
$4,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,027.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,712.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,945.60
|
| Rate for Payer: Altius Commercial |
$3,945.60
|
| Rate for Payer: Beech Street Commercial |
$4,027.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,374.31
|
| Rate for Payer: Cash Price |
$2,877.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,986.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,027.80
|
| Rate for Payer: Entrust Commercial |
$3,904.50
|
| Rate for Payer: First Choice Health Commercial |
$3,904.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,904.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,383.80
|
| Rate for Payer: HealthUtah PPO |
$4,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,986.70
|
| Rate for Payer: Multiplan Medicare/VA |
$2,264.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4,027.80
|
| Rate for Payer: PacificSource Commercial |
$3,699.00
|
| Rate for Payer: PHCS PPO |
$4,027.80
|
| Rate for Payer: Three Rivers PPO |
$3,082.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,383.80
|
| Rate for Payer: United Healthcare Commercial |
$3,575.70
|
| Rate for Payer: United Healthcare Medicare |
$2,383.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,027.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3,904.50
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
7614908301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.30
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$285.28
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.30
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.77 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$368.64
|
| Rate for Payer: Altius Commercial |
$368.64
|
| Rate for Payer: Beech Street Commercial |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$315.26
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$372.48
|
| Rate for Payer: Cigna of WY Commercial |
$376.32
|
| Rate for Payer: Entrust Commercial |
$364.80
|
| Rate for Payer: First Choice Health Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.44
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$240.77
|
| Rate for Payer: One Health Plan of WY PPO |
$376.32
|
| Rate for Payer: PacificSource Commercial |
$345.60
|
| Rate for Payer: PHCS PPO |
$376.32
|
| Rate for Payer: Three Rivers PPO |
$288.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.44
|
| Rate for Payer: United Healthcare Commercial |
$334.08
|
| Rate for Payer: United Healthcare Medicare |
$253.44
|
| Rate for Payer: WINHealth Partners Commercial |
$364.80
|
| Rate for Payer: Wise Provider Network Commercial |
$364.80
|
|
