|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Aetna of WY Medicare |
$253.44
|
| 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 |
$222.72
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$211.58
|
| 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 |
$222.72
|
| Rate for Payer: United Healthcare Commercial |
$334.08
|
| Rate for Payer: United Healthcare Medicare |
$222.72
|
| Rate for Payer: WINHealth Partners Commercial |
$376.32
|
| Rate for Payer: Wise Provider Network Commercial |
$364.80
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
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 ACNE SURGERY
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
5101004001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.88
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.51
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.98
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$33.23
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$34.98
|
| Rate for Payer: United Healthcare Commercial |
$46.11
|
| Rate for Payer: United Healthcare Medicare |
$34.98
|
| Rate for Payer: WINHealth Partners Commercial |
$50.35
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC ACNE SURGERY
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
5101004001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$34.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.88
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.51
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.74
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$29.20
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$30.74
|
| Rate for Payer: United Healthcare Commercial |
$46.11
|
| Rate for Payer: United Healthcare Medicare |
$30.74
|
| Rate for Payer: WINHealth Partners Commercial |
$51.94
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
3058530701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
3058530701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$556.51 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$989.80
|
| Rate for Payer: Aetna of WY Medicare |
$666.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$969.60
|
| Rate for Payer: Altius Commercial |
$969.60
|
| Rate for Payer: Beech Street Commercial |
$989.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$829.21
|
| Rate for Payer: Cash Price |
$707.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$979.70
|
| Rate for Payer: Cigna of WY Commercial |
$989.80
|
| Rate for Payer: Entrust Commercial |
$959.50
|
| Rate for Payer: First Choice Health Commercial |
$959.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$959.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$585.80
|
| Rate for Payer: HealthUtah PPO |
$1,010.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$979.70
|
| Rate for Payer: Multiplan Medicare/VA |
$556.51
|
| Rate for Payer: One Health Plan of WY PPO |
$989.80
|
| Rate for Payer: PacificSource Commercial |
$909.00
|
| Rate for Payer: PHCS PPO |
$989.80
|
| Rate for Payer: Three Rivers PPO |
$757.50
|
| Rate for Payer: TriWest Veterans Administration |
$585.80
|
| Rate for Payer: United Healthcare Commercial |
$878.70
|
| Rate for Payer: United Healthcare Medicare |
$585.80
|
| Rate for Payer: WINHealth Partners Commercial |
$989.80
|
| Rate for Payer: Wise Provider Network Commercial |
$959.50
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$633.27 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$989.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$969.60
|
| Rate for Payer: Altius Commercial |
$969.60
|
| Rate for Payer: Beech Street Commercial |
$989.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$829.21
|
| Rate for Payer: Cash Price |
$707.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$979.70
|
| Rate for Payer: Cigna of WY Commercial |
$989.80
|
| Rate for Payer: Entrust Commercial |
$959.50
|
| Rate for Payer: First Choice Health Commercial |
$959.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$959.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$666.60
|
| Rate for Payer: HealthUtah PPO |
$1,010.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$979.70
|
| Rate for Payer: Multiplan Medicare/VA |
$633.27
|
| Rate for Payer: One Health Plan of WY PPO |
$989.80
|
| Rate for Payer: PacificSource Commercial |
$909.00
|
| Rate for Payer: PHCS PPO |
$989.80
|
| Rate for Payer: Three Rivers PPO |
$757.50
|
| Rate for Payer: TriWest Veterans Administration |
$666.60
|
| Rate for Payer: United Healthcare Commercial |
$878.70
|
| Rate for Payer: United Healthcare Medicare |
$666.60
|
| Rate for Payer: WINHealth Partners Commercial |
$959.50
|
| Rate for Payer: Wise Provider Network Commercial |
$959.50
|
|
|
HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES, PLASMA, QUANT
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
3018201701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES, PLASMA, QUANT
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
3018201701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ADENOVIRUS DNA QN
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$427.02 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$759.50
|
| Rate for Payer: Aetna of WY Medicare |
$511.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$744.00
|
| Rate for Payer: Altius Commercial |
$744.00
|
| Rate for Payer: Beech Street Commercial |
$759.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$636.28
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$751.75
|
| Rate for Payer: Cigna of WY Commercial |
$759.50
|
| Rate for Payer: Entrust Commercial |
$736.25
|
| Rate for Payer: First Choice Health Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.50
|
| Rate for Payer: HealthUtah PPO |
$775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$751.75
|
| Rate for Payer: Multiplan Medicare/VA |
$427.02
|
| Rate for Payer: One Health Plan of WY PPO |
$759.50
|
| Rate for Payer: PacificSource Commercial |
$697.50
|
| Rate for Payer: PHCS PPO |
$759.50
|
| Rate for Payer: Three Rivers PPO |
$581.25
|
| Rate for Payer: TriWest Veterans Administration |
$449.50
|
| Rate for Payer: United Healthcare Commercial |
$674.25
|
| Rate for Payer: United Healthcare Medicare |
$449.50
|
| Rate for Payer: WINHealth Partners Commercial |
$759.50
|
| Rate for Payer: Wise Provider Network Commercial |
$736.25
|
|
|
HC ADENOVIRUS DNA QN
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$485.92 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$759.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$744.00
|
| Rate for Payer: Altius Commercial |
$744.00
|
| Rate for Payer: Beech Street Commercial |
$759.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$636.28
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$751.75
|
| Rate for Payer: Cigna of WY Commercial |
$759.50
|
| Rate for Payer: Entrust Commercial |
$736.25
|
| Rate for Payer: First Choice Health Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.50
|
| Rate for Payer: HealthUtah PPO |
$775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$751.75
|
| Rate for Payer: Multiplan Medicare/VA |
$485.92
|
| Rate for Payer: One Health Plan of WY PPO |
$759.50
|
| Rate for Payer: PacificSource Commercial |
$697.50
|
| Rate for Payer: PHCS PPO |
$759.50
|
| Rate for Payer: Three Rivers PPO |
$581.25
|
| Rate for Payer: TriWest Veterans Administration |
$511.50
|
| Rate for Payer: United Healthcare Commercial |
$674.25
|
| Rate for Payer: United Healthcare Medicare |
$511.50
|
| Rate for Payer: WINHealth Partners Commercial |
$736.25
|
| Rate for Payer: Wise Provider Network Commercial |
$736.25
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
OP
|
$2,802.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
5101402001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,543.90 |
| Max. Negotiated Rate |
$2,802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,745.96
|
| Rate for Payer: Aetna of WY Medicare |
$1,849.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,689.92
|
| Rate for Payer: Altius Commercial |
$2,689.92
|
| Rate for Payer: Beech Street Commercial |
$2,745.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,300.44
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,717.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,745.96
|
| Rate for Payer: Entrust Commercial |
$2,661.90
|
| Rate for Payer: First Choice Health Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,625.16
|
| Rate for Payer: HealthUtah PPO |
$2,802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,717.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,543.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,745.96
|
| Rate for Payer: PacificSource Commercial |
$2,521.80
|
| Rate for Payer: PHCS PPO |
$2,745.96
|
| Rate for Payer: Three Rivers PPO |
$2,101.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,625.16
|
| Rate for Payer: United Healthcare Commercial |
$2,437.74
|
| Rate for Payer: United Healthcare Medicare |
$1,625.16
|
| Rate for Payer: WINHealth Partners Commercial |
$2,745.96
|
| Rate for Payer: Wise Provider Network Commercial |
$2,661.90
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
7611404001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.52
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$421.34
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$443.52
|
| Rate for Payer: WINHealth Partners Commercial |
$638.40
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
7611404001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$443.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.76
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$370.27
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$389.76
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$389.76
|
| Rate for Payer: WINHealth Partners Commercial |
$658.56
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
IP
|
$2,802.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
5101402001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,756.85 |
| Max. Negotiated Rate |
$2,802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,745.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,689.92
|
| Rate for Payer: Altius Commercial |
$2,689.92
|
| Rate for Payer: Beech Street Commercial |
$2,745.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,300.44
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,717.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,745.96
|
| Rate for Payer: Entrust Commercial |
$2,661.90
|
| Rate for Payer: First Choice Health Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,849.32
|
| Rate for Payer: HealthUtah PPO |
$2,802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,717.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,756.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,745.96
|
| Rate for Payer: PacificSource Commercial |
$2,521.80
|
| Rate for Payer: PHCS PPO |
$2,745.96
|
| Rate for Payer: Three Rivers PPO |
$2,101.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,849.32
|
| Rate for Payer: United Healthcare Commercial |
$2,437.74
|
| Rate for Payer: United Healthcare Medicare |
$1,849.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2,661.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,661.90
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
771G000901
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
771G000901
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Aetna of WY Medicare |
$11.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Multiplan Medicare/VA |
$9.37
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: WINHealth Partners Commercial |
$16.66
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.22
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Multiplan Medicare/VA |
$10.66
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.22
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Medicare |
$11.22
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
