|
ELECTRODE LEEP LOOP 2CM X 2CM
|
Facility
|
OP
|
$92.44
|
|
| Hospital Charge Code |
2650986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.59
|
| Rate for Payer: Aetna of WY Medicare |
$61.01
|
| Rate for Payer: Altius Commercial |
$88.74
|
| Rate for Payer: Beech Street Commercial |
$90.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.67
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.67
|
| Rate for Payer: Cigna of WY Commercial |
$90.59
|
| Rate for Payer: Entrust Commercial |
$87.82
|
| Rate for Payer: First Choice Health Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.69
|
| Rate for Payer: HealthUtah PPO |
$92.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.67
|
| Rate for Payer: Multiplan Medicare/VA |
$50.06
|
| Rate for Payer: One Health Plan of WY PPO |
$90.59
|
| Rate for Payer: PacificSource Commercial |
$83.20
|
| Rate for Payer: PHCS PPO |
$90.59
|
| Rate for Payer: Three Rivers PPO |
$69.33
|
| Rate for Payer: TriWest Veterans Administration |
$52.69
|
| Rate for Payer: United Healthcare Commercial |
$88.28
|
| Rate for Payer: United Healthcare Medicare |
$52.69
|
| Rate for Payer: WINHealth Partners Commercial |
$90.59
|
| Rate for Payer: Wise Provider Network Commercial |
$87.82
|
|
|
ELECTRODE RESTING TAB ECG
|
Facility
|
IP
|
$10.54
|
|
| Hospital Charge Code |
2400096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.75
|
| Rate for Payer: Altius Commercial |
$10.12
|
| Rate for Payer: Beech Street Commercial |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.22
|
| Rate for Payer: Cigna of WY Commercial |
$10.33
|
| Rate for Payer: Entrust Commercial |
$10.01
|
| Rate for Payer: First Choice Health Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.43
|
| Rate for Payer: HealthUtah PPO |
$10.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.22
|
| Rate for Payer: Multiplan Medicare/VA |
$6.11
|
| Rate for Payer: One Health Plan of WY PPO |
$10.33
|
| Rate for Payer: PacificSource Commercial |
$9.49
|
| Rate for Payer: PHCS PPO |
$10.33
|
| Rate for Payer: Three Rivers PPO |
$7.90
|
| Rate for Payer: TriWest Veterans Administration |
$6.43
|
| Rate for Payer: United Healthcare Commercial |
$10.07
|
| Rate for Payer: United Healthcare Medicare |
$6.43
|
| Rate for Payer: WINHealth Partners Commercial |
$10.01
|
| Rate for Payer: Wise Provider Network Commercial |
$10.01
|
|
|
ELECTRODE RESTING TAB ECG
|
Facility
|
OP
|
$10.54
|
|
| Hospital Charge Code |
2400096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.96
|
| Rate for Payer: Altius Commercial |
$10.12
|
| Rate for Payer: Beech Street Commercial |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.22
|
| Rate for Payer: Cigna of WY Commercial |
$10.33
|
| Rate for Payer: Entrust Commercial |
$10.01
|
| Rate for Payer: First Choice Health Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.01
|
| Rate for Payer: HealthUtah PPO |
$10.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.22
|
| Rate for Payer: Multiplan Medicare/VA |
$5.71
|
| Rate for Payer: One Health Plan of WY PPO |
$10.33
|
| Rate for Payer: PacificSource Commercial |
$9.49
|
| Rate for Payer: PHCS PPO |
$10.33
|
| Rate for Payer: Three Rivers PPO |
$7.90
|
| Rate for Payer: TriWest Veterans Administration |
$6.01
|
| Rate for Payer: United Healthcare Commercial |
$10.07
|
| Rate for Payer: United Healthcare Medicare |
$6.01
|
| Rate for Payer: WINHealth Partners Commercial |
$10.33
|
| Rate for Payer: Wise Provider Network Commercial |
$10.01
|
|
|
ELECTROLYTE PANEL
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 80051
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$7.01
|
| Rate for Payer: Beech Street Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: First Choice Health Commercial |
$72.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.01
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$5.96
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$76.95
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$7.01
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
|
|
ELECTROLYTE-S IVPB BOLUS (ISOLYTE) [4090000075]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.62
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
ELECTROLYTE-S IVPB BOLUS (ISOLYTE) [4090000075]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.57
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.14
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Medicare |
$8.57
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
ELECTROLYTE-S (PH 7.4) INTRAVENOUS SOLUTION [2756]
|
Facility
|
IP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.62
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: WINHealth Partners Commercial |
$14.28
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
ELECTROLYTE-S (PH 7.4) INTRAVENOUS SOLUTION [2756]
|
Facility
|
OP
|
$15.03
|
|
|
Service Code
|
NDC 0264770700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.73
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Commercial |
$14.43
|
| Rate for Payer: Beech Street Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.58
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.58
|
| Rate for Payer: Cigna of WY Commercial |
$14.73
|
| Rate for Payer: Entrust Commercial |
$14.28
|
| Rate for Payer: First Choice Health Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.57
|
| Rate for Payer: HealthUtah PPO |
$15.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.14
|
| Rate for Payer: One Health Plan of WY PPO |
$14.73
|
| Rate for Payer: PacificSource Commercial |
$13.53
|
| Rate for Payer: PHCS PPO |
$14.73
|
| Rate for Payer: Three Rivers PPO |
$11.27
|
| Rate for Payer: TriWest Veterans Administration |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$14.35
|
| Rate for Payer: United Healthcare Medicare |
$8.57
|
| Rate for Payer: WINHealth Partners Commercial |
$14.73
|
| Rate for Payer: Wise Provider Network Commercial |
$14.28
|
|
|
E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Beech Street Commercial |
$195.70
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: First Choice Health Commercial |
$185.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$195.70
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
| Rate for Payer: WINHealth Partners Commercial |
$195.70
|
|
|
EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$7,947.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$466.83 |
| Max. Negotiated Rate |
$7,947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,788.06
|
| Rate for Payer: Aetna of WY Medicare |
$549.21
|
| Rate for Payer: Beech Street Commercial |
$7,549.65
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,708.59
|
| Rate for Payer: Cigna of WY Commercial |
$7,788.06
|
| Rate for Payer: First Choice Health Commercial |
$7,152.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,549.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.21
|
| Rate for Payer: HealthUtah PPO |
$7,947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,708.59
|
| Rate for Payer: Multiplan Medicare/VA |
$466.83
|
| Rate for Payer: One Health Plan of WY PPO |
$7,788.06
|
| Rate for Payer: PacificSource Commercial |
$7,152.30
|
| Rate for Payer: PHCS PPO |
$7,549.65
|
| Rate for Payer: Three Rivers PPO |
$5,960.25
|
| Rate for Payer: TriWest Veterans Administration |
$549.21
|
| Rate for Payer: United Healthcare Commercial |
$7,549.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6,754.95
|
|
|
EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$7,947.00
|
|
|
Service Code
|
HCPCS 34111 AS
|
| Min. Negotiated Rate |
$466.83 |
| Max. Negotiated Rate |
$7,947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,788.06
|
| Rate for Payer: Beech Street Commercial |
$7,549.65
|
| Rate for Payer: Cash Price |
$5,562.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,708.59
|
| Rate for Payer: Cigna of WY Commercial |
$7,788.06
|
| Rate for Payer: First Choice Health Commercial |
$7,152.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,549.65
|
| Rate for Payer: HealthUtah PPO |
$7,947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,708.59
|
| Rate for Payer: One Health Plan of WY PPO |
$7,788.06
|
| Rate for Payer: PacificSource Commercial |
$7,152.30
|
| Rate for Payer: PHCS PPO |
$7,549.65
|
| Rate for Payer: Three Rivers PPO |
$5,960.25
|
| Rate for Payer: United Healthcare Commercial |
$7,549.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6,754.95
|
|
|
EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$1,808.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$1,771.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$166.68
|
| Rate for Payer: Beech Street Commercial |
$1,717.60
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: First Choice Health Commercial |
$1,627.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.68
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$141.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,717.60
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$166.68
|
| Rate for Payer: United Healthcare Commercial |
$1,717.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
|
|
EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$714.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$714.42
|
| Rate for Payer: Aetna of WY Medicare |
$67.64
|
| Rate for Payer: Beech Street Commercial |
$692.55
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$707.13
|
| Rate for Payer: Cigna of WY Commercial |
$714.42
|
| Rate for Payer: First Choice Health Commercial |
$656.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$692.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.64
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$707.13
|
| Rate for Payer: Multiplan Medicare/VA |
$57.49
|
| Rate for Payer: One Health Plan of WY PPO |
$714.42
|
| Rate for Payer: PacificSource Commercial |
$656.10
|
| Rate for Payer: PHCS PPO |
$692.55
|
| Rate for Payer: Three Rivers PPO |
$546.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
| Rate for Payer: WINHealth Partners Commercial |
$692.55
|
|
|
EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$219.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Beech Street Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.28
|
| Rate for Payer: Cigna of WY Commercial |
$219.52
|
| Rate for Payer: First Choice Health Commercial |
$201.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.88
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$219.52
|
| Rate for Payer: PacificSource Commercial |
$201.60
|
| Rate for Payer: PHCS PPO |
$212.80
|
| Rate for Payer: Three Rivers PPO |
$168.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
| Rate for Payer: WINHealth Partners Commercial |
$212.80
|
|
|
EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$1,216.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,216.18
|
| Rate for Payer: Aetna of WY Medicare |
$115.07
|
| Rate for Payer: Beech Street Commercial |
$1,178.95
|
| Rate for Payer: Cash Price |
$868.70
|
| Rate for Payer: Cash Price |
$868.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,203.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,216.18
|
| Rate for Payer: First Choice Health Commercial |
$1,116.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,178.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.07
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,203.77
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,216.18
|
| Rate for Payer: PacificSource Commercial |
$1,116.90
|
| Rate for Payer: PHCS PPO |
$1,178.95
|
| Rate for Payer: Three Rivers PPO |
$930.75
|
| Rate for Payer: TriWest Veterans Administration |
$115.07
|
| Rate for Payer: United Healthcare Commercial |
$1,178.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,178.95
|
|
|
EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$466.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$466.48
|
| Rate for Payer: Aetna of WY Medicare |
$39.75
|
| Rate for Payer: Beech Street Commercial |
$452.20
|
| Rate for Payer: Cash Price |
$333.20
|
| Rate for Payer: Cash Price |
$333.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$461.72
|
| Rate for Payer: Cigna of WY Commercial |
$466.48
|
| Rate for Payer: First Choice Health Commercial |
$428.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$452.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.75
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$461.72
|
| Rate for Payer: Multiplan Medicare/VA |
$33.79
|
| Rate for Payer: One Health Plan of WY PPO |
$466.48
|
| Rate for Payer: PacificSource Commercial |
$428.40
|
| Rate for Payer: PHCS PPO |
$452.20
|
| Rate for Payer: Three Rivers PPO |
$357.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.75
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
| Rate for Payer: WINHealth Partners Commercial |
$452.20
|
|
|
EMG BIPOLAR BAG GOLD .5" DISCS
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
2400270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$164.64
|
| Rate for Payer: Aetna of WY Medicare |
$107.52
|
| Rate for Payer: Altius Commercial |
$161.28
|
| Rate for Payer: Beech Street Commercial |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.96
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$162.96
|
| Rate for Payer: Cigna of WY Commercial |
$164.64
|
| Rate for Payer: Entrust Commercial |
$159.60
|
| Rate for Payer: First Choice Health Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.48
|
| Rate for Payer: HealthUtah PPO |
$168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$162.96
|
| Rate for Payer: Multiplan Medicare/VA |
$97.36
|
| Rate for Payer: One Health Plan of WY PPO |
$164.64
|
| Rate for Payer: PacificSource Commercial |
$151.20
|
| Rate for Payer: PHCS PPO |
$164.64
|
| Rate for Payer: Three Rivers PPO |
$126.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.48
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Medicare |
$102.48
|
| Rate for Payer: WINHealth Partners Commercial |
$159.60
|
| Rate for Payer: Wise Provider Network Commercial |
$159.60
|
|
|
EMG BIPOLAR BAG GOLD .5" DISCS
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
2400270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$164.64
|
| Rate for Payer: Aetna of WY Medicare |
$110.88
|
| Rate for Payer: Altius Commercial |
$161.28
|
| Rate for Payer: Beech Street Commercial |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.96
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$162.96
|
| Rate for Payer: Cigna of WY Commercial |
$164.64
|
| Rate for Payer: Entrust Commercial |
$159.60
|
| Rate for Payer: First Choice Health Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.76
|
| Rate for Payer: HealthUtah PPO |
$168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$162.96
|
| Rate for Payer: Multiplan Medicare/VA |
$90.97
|
| Rate for Payer: One Health Plan of WY PPO |
$164.64
|
| Rate for Payer: PacificSource Commercial |
$151.20
|
| Rate for Payer: PHCS PPO |
$164.64
|
| Rate for Payer: Three Rivers PPO |
$126.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.76
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Medicare |
$95.76
|
| Rate for Payer: WINHealth Partners Commercial |
$164.64
|
| Rate for Payer: Wise Provider Network Commercial |
$159.60
|
|
|
EMG BIPOLAR FELT PAD ELECTRODE
|
Facility
|
OP
|
$220.50
|
|
| Hospital Charge Code |
2400268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.09
|
| Rate for Payer: Aetna of WY Medicare |
$145.53
|
| Rate for Payer: Altius Commercial |
$211.68
|
| Rate for Payer: Beech Street Commercial |
$216.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.88
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.88
|
| Rate for Payer: Cigna of WY Commercial |
$216.09
|
| Rate for Payer: Entrust Commercial |
$209.48
|
| Rate for Payer: First Choice Health Commercial |
$209.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.68
|
| Rate for Payer: HealthUtah PPO |
$220.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.88
|
| Rate for Payer: Multiplan Medicare/VA |
$119.40
|
| Rate for Payer: One Health Plan of WY PPO |
$216.09
|
| Rate for Payer: PacificSource Commercial |
$198.45
|
| Rate for Payer: PHCS PPO |
$216.09
|
| Rate for Payer: Three Rivers PPO |
$165.38
|
| Rate for Payer: TriWest Veterans Administration |
$125.68
|
| Rate for Payer: United Healthcare Commercial |
$210.58
|
| Rate for Payer: United Healthcare Medicare |
$125.68
|
| Rate for Payer: WINHealth Partners Commercial |
$216.09
|
| Rate for Payer: Wise Provider Network Commercial |
$209.48
|
|
|
EMG BIPOLAR FELT PAD ELECTRODE
|
Facility
|
IP
|
$220.50
|
|
| Hospital Charge Code |
2400268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.78 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.09
|
| Rate for Payer: Aetna of WY Medicare |
$141.12
|
| Rate for Payer: Altius Commercial |
$211.68
|
| Rate for Payer: Beech Street Commercial |
$216.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.88
|
| Rate for Payer: Cash Price |
$154.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.88
|
| Rate for Payer: Cigna of WY Commercial |
$216.09
|
| Rate for Payer: Entrust Commercial |
$209.48
|
| Rate for Payer: First Choice Health Commercial |
$209.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.50
|
| Rate for Payer: HealthUtah PPO |
$220.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.88
|
| Rate for Payer: Multiplan Medicare/VA |
$127.78
|
| Rate for Payer: One Health Plan of WY PPO |
$216.09
|
| Rate for Payer: PacificSource Commercial |
$198.45
|
| Rate for Payer: PHCS PPO |
$216.09
|
| Rate for Payer: Three Rivers PPO |
$165.38
|
| Rate for Payer: TriWest Veterans Administration |
$134.50
|
| Rate for Payer: United Healthcare Commercial |
$210.58
|
| Rate for Payer: United Healthcare Medicare |
$134.50
|
| Rate for Payer: WINHealth Partners Commercial |
$209.48
|
| Rate for Payer: Wise Provider Network Commercial |
$209.48
|
|
|
EMG DISK ELECTRODE 39" LEAD
|
Facility
|
IP
|
$143.50
|
|
| Hospital Charge Code |
2400266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.63
|
| Rate for Payer: Aetna of WY Medicare |
$91.84
|
| Rate for Payer: Altius Commercial |
$137.76
|
| Rate for Payer: Beech Street Commercial |
$140.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.20
|
| Rate for Payer: Cash Price |
$100.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.20
|
| Rate for Payer: Cigna of WY Commercial |
$140.63
|
| Rate for Payer: Entrust Commercial |
$136.32
|
| Rate for Payer: First Choice Health Commercial |
$136.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.54
|
| Rate for Payer: HealthUtah PPO |
$143.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.20
|
| Rate for Payer: Multiplan Medicare/VA |
$83.16
|
| Rate for Payer: One Health Plan of WY PPO |
$140.63
|
| Rate for Payer: PacificSource Commercial |
$129.15
|
| Rate for Payer: PHCS PPO |
$140.63
|
| Rate for Payer: Three Rivers PPO |
$107.62
|
| Rate for Payer: TriWest Veterans Administration |
$87.54
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$87.54
|
| Rate for Payer: WINHealth Partners Commercial |
$136.32
|
| Rate for Payer: Wise Provider Network Commercial |
$136.32
|
|
|
EMG DISK ELECTRODE 39" LEAD
|
Facility
|
OP
|
$143.50
|
|
| Hospital Charge Code |
2400266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.63
|
| Rate for Payer: Aetna of WY Medicare |
$94.71
|
| Rate for Payer: Altius Commercial |
$137.76
|
| Rate for Payer: Beech Street Commercial |
$140.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.20
|
| Rate for Payer: Cash Price |
$100.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.20
|
| Rate for Payer: Cigna of WY Commercial |
$140.63
|
| Rate for Payer: Entrust Commercial |
$136.32
|
| Rate for Payer: First Choice Health Commercial |
$136.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.80
|
| Rate for Payer: HealthUtah PPO |
$143.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.20
|
| Rate for Payer: Multiplan Medicare/VA |
$77.71
|
| Rate for Payer: One Health Plan of WY PPO |
$140.63
|
| Rate for Payer: PacificSource Commercial |
$129.15
|
| Rate for Payer: PHCS PPO |
$140.63
|
| Rate for Payer: Three Rivers PPO |
$107.62
|
| Rate for Payer: TriWest Veterans Administration |
$81.80
|
| Rate for Payer: United Healthcare Commercial |
$137.04
|
| Rate for Payer: United Healthcare Medicare |
$81.80
|
| Rate for Payer: WINHealth Partners Commercial |
$140.63
|
| Rate for Payer: Wise Provider Network Commercial |
$136.32
|
|
|
EMG DISK GROUNDING .75"D 30"L
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
2400267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$40.32
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.43
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$36.51
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.43
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare |
$38.43
|
| Rate for Payer: WINHealth Partners Commercial |
$59.85
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
EMG DISK GROUNDING .75"D 30"L
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
2400267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.91
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$34.11
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.91
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare |
$35.91
|
| Rate for Payer: WINHealth Partners Commercial |
$61.74
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
EMG HUSH BIPOLAR BAR ELECTRODE
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
2400269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.56 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$603.68
|
| Rate for Payer: Aetna of WY Medicare |
$406.56
|
| Rate for Payer: Altius Commercial |
$591.36
|
| Rate for Payer: Beech Street Commercial |
$603.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$597.52
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$597.52
|
| Rate for Payer: Cigna of WY Commercial |
$603.68
|
| Rate for Payer: Entrust Commercial |
$585.20
|
| Rate for Payer: First Choice Health Commercial |
$585.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$585.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.12
|
| Rate for Payer: HealthUtah PPO |
$616.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$597.52
|
| Rate for Payer: Multiplan Medicare/VA |
$333.56
|
| Rate for Payer: One Health Plan of WY PPO |
$603.68
|
| Rate for Payer: PacificSource Commercial |
$554.40
|
| Rate for Payer: PHCS PPO |
$603.68
|
| Rate for Payer: Three Rivers PPO |
$462.00
|
| Rate for Payer: TriWest Veterans Administration |
$351.12
|
| Rate for Payer: United Healthcare Commercial |
$588.28
|
| Rate for Payer: United Healthcare Medicare |
$351.12
|
| Rate for Payer: WINHealth Partners Commercial |
$603.68
|
| Rate for Payer: Wise Provider Network Commercial |
$585.20
|
|
