|
HC AMINO ACIDS, SINGLE QUANTITATION - TRYPTOPHAN PLASMA
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Aetna of WY Medicare |
$135.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.90
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$112.96
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.90
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$118.90
|
| Rate for Payer: WINHealth Partners Commercial |
$200.90
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - TRYPTOPHAN PLASMA
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.30
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$128.54
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$135.30
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$135.30
|
| Rate for Payer: WINHealth Partners Commercial |
$194.75
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC AMNIOCENTESIS DIAGNOSIC
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
5105900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.84
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$26.45
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.84
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$27.84
|
| Rate for Payer: WINHealth Partners Commercial |
$47.04
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC AMNIOCENTESIS DIAGNOSIC
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
5105900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.68
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.10
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.68
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$31.68
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC AMNIOCENTESIS,DIAGNOSTIC
|
Facility
|
OP
|
$4,230.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
4025900001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,330.73 |
| Max. Negotiated Rate |
$4,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,145.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,791.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,060.80
|
| Rate for Payer: Altius Commercial |
$4,060.80
|
| Rate for Payer: Beech Street Commercial |
$4,145.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,472.83
|
| Rate for Payer: Cash Price |
$2,961.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,103.10
|
| Rate for Payer: Cigna of WY Commercial |
$4,145.40
|
| Rate for Payer: Entrust Commercial |
$4,018.50
|
| Rate for Payer: First Choice Health Commercial |
$4,018.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,018.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,453.40
|
| Rate for Payer: HealthUtah PPO |
$4,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,103.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,330.73
|
| Rate for Payer: One Health Plan of WY PPO |
$4,145.40
|
| Rate for Payer: PacificSource Commercial |
$3,807.00
|
| Rate for Payer: PHCS PPO |
$4,145.40
|
| Rate for Payer: Three Rivers PPO |
$3,172.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,453.40
|
| Rate for Payer: United Healthcare Commercial |
$3,680.10
|
| Rate for Payer: United Healthcare Medicare |
$2,453.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4,145.40
|
| Rate for Payer: Wise Provider Network Commercial |
$4,018.50
|
|
|
HC AMNIOCENTESIS,DIAGNOSTIC
|
Facility
|
IP
|
$4,230.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
4025900001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,652.21 |
| Max. Negotiated Rate |
$4,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,145.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,060.80
|
| Rate for Payer: Altius Commercial |
$4,060.80
|
| Rate for Payer: Beech Street Commercial |
$4,145.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,472.83
|
| Rate for Payer: Cash Price |
$2,961.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,103.10
|
| Rate for Payer: Cigna of WY Commercial |
$4,145.40
|
| Rate for Payer: Entrust Commercial |
$4,018.50
|
| Rate for Payer: First Choice Health Commercial |
$4,018.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,018.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,791.80
|
| Rate for Payer: HealthUtah PPO |
$4,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,103.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,652.21
|
| Rate for Payer: One Health Plan of WY PPO |
$4,145.40
|
| Rate for Payer: PacificSource Commercial |
$3,807.00
|
| Rate for Payer: PHCS PPO |
$4,145.40
|
| Rate for Payer: Three Rivers PPO |
$3,172.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,791.80
|
| Rate for Payer: United Healthcare Commercial |
$3,680.10
|
| Rate for Payer: United Healthcare Medicare |
$2,791.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,018.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,018.50
|
|
|
HC AMPUTATION FINGER/THUMB
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
7612695101
|
|
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 AMPUTATION FINGER/THUMB
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
7612695101
|
|
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 ANESTHESIA EPIDURAL BLOCK
|
Facility
|
OP
|
$215.00
|
|
| Hospital Charge Code |
3700000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC ANESTHESIA EPIDURAL BLOCK
|
Facility
|
IP
|
$215.00
|
|
| Hospital Charge Code |
3700000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC ANESTHESIA ER
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
3700000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC ANESTHESIA ER
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
3700000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC ANESTHESIA GENERAL SET UP
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$536.08 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.30
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$536.08
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.30
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$564.30
|
| Rate for Payer: WINHealth Partners Commercial |
$812.25
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC ANESTHESIA GENERAL SET UP
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Aetna of WY Medicare |
$564.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.90
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$471.10
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$495.90
|
| Rate for Payer: WINHealth Partners Commercial |
$837.90
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC ANESTHESIA LEVEL - MAC
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
3700000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC ANESTHESIA LEVEL - MAC
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
3700000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC ANESTHESIA SUPPLY ANESTH
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
3700000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC ANESTHESIA SUPPLY ANESTH
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
3700000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ANNUAL DEPRESSION SCREENING EA 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
510G044401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC ANNUAL DEPRESSION SCREENING EA 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
510G044401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC ANTEPARTUM CARE ONLY 4-6 VISITS
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
5105942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.61 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$137.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$199.68
|
| Rate for Payer: Altius Commercial |
$199.68
|
| Rate for Payer: Beech Street Commercial |
$203.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$170.77
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: Entrust Commercial |
$197.60
|
| Rate for Payer: First Choice Health Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.64
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$114.61
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$203.84
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$120.64
|
| Rate for Payer: United Healthcare Commercial |
$180.96
|
| Rate for Payer: United Healthcare Medicare |
$120.64
|
| Rate for Payer: WINHealth Partners Commercial |
$203.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.60
|
|
