|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$648.94 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,014.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$993.60
|
| Rate for Payer: Altius Commercial |
$993.60
|
| Rate for Payer: Beech Street Commercial |
$1,014.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$849.74
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,003.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,014.30
|
| Rate for Payer: Entrust Commercial |
$983.25
|
| Rate for Payer: First Choice Health Commercial |
$983.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$983.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$683.10
|
| Rate for Payer: HealthUtah PPO |
$1,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,003.95
|
| Rate for Payer: Multiplan Medicare/VA |
$648.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,014.30
|
| Rate for Payer: PacificSource Commercial |
$931.50
|
| Rate for Payer: PHCS PPO |
$1,014.30
|
| Rate for Payer: Three Rivers PPO |
$776.25
|
| Rate for Payer: TriWest Veterans Administration |
$683.10
|
| Rate for Payer: United Healthcare Commercial |
$900.45
|
| Rate for Payer: United Healthcare Medicare |
$683.10
|
| Rate for Payer: WINHealth Partners Commercial |
$983.25
|
| Rate for Payer: Wise Provider Network Commercial |
$983.25
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,014.30
|
| Rate for Payer: Aetna of WY Medicare |
$683.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$993.60
|
| Rate for Payer: Altius Commercial |
$993.60
|
| Rate for Payer: Beech Street Commercial |
$1,014.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$849.74
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,003.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,014.30
|
| Rate for Payer: Entrust Commercial |
$983.25
|
| Rate for Payer: First Choice Health Commercial |
$983.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$983.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$600.30
|
| Rate for Payer: HealthUtah PPO |
$1,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,003.95
|
| Rate for Payer: Multiplan Medicare/VA |
$570.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,014.30
|
| Rate for Payer: PacificSource Commercial |
$931.50
|
| Rate for Payer: PHCS PPO |
$1,014.30
|
| Rate for Payer: Three Rivers PPO |
$776.25
|
| Rate for Payer: TriWest Veterans Administration |
$600.30
|
| Rate for Payer: United Healthcare Commercial |
$900.45
|
| Rate for Payer: United Healthcare Medicare |
$600.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,014.30
|
| Rate for Payer: Wise Provider Network Commercial |
$983.25
|
|
|
HC CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
5105416101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$194.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$190.08
|
| Rate for Payer: Altius Commercial |
$190.08
|
| Rate for Payer: Beech Street Commercial |
$194.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.56
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$192.06
|
| Rate for Payer: Cigna of WY Commercial |
$194.04
|
| Rate for Payer: Entrust Commercial |
$188.10
|
| Rate for Payer: First Choice Health Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.68
|
| Rate for Payer: HealthUtah PPO |
$198.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$192.06
|
| Rate for Payer: Multiplan Medicare/VA |
$124.15
|
| Rate for Payer: One Health Plan of WY PPO |
$194.04
|
| Rate for Payer: PacificSource Commercial |
$178.20
|
| Rate for Payer: PHCS PPO |
$194.04
|
| Rate for Payer: Three Rivers PPO |
$148.50
|
| Rate for Payer: TriWest Veterans Administration |
$130.68
|
| Rate for Payer: United Healthcare Commercial |
$172.26
|
| Rate for Payer: United Healthcare Medicare |
$130.68
|
| Rate for Payer: WINHealth Partners Commercial |
$188.10
|
| Rate for Payer: Wise Provider Network Commercial |
$188.10
|
|
|
HC CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
5105416101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.10 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$194.04
|
| Rate for Payer: Aetna of WY Medicare |
$130.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$190.08
|
| Rate for Payer: Altius Commercial |
$190.08
|
| Rate for Payer: Beech Street Commercial |
$194.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.56
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$192.06
|
| Rate for Payer: Cigna of WY Commercial |
$194.04
|
| Rate for Payer: Entrust Commercial |
$188.10
|
| Rate for Payer: First Choice Health Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.84
|
| Rate for Payer: HealthUtah PPO |
$198.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$192.06
|
| Rate for Payer: Multiplan Medicare/VA |
$109.10
|
| Rate for Payer: One Health Plan of WY PPO |
$194.04
|
| Rate for Payer: PacificSource Commercial |
$178.20
|
| Rate for Payer: PHCS PPO |
$194.04
|
| Rate for Payer: Three Rivers PPO |
$148.50
|
| Rate for Payer: TriWest Veterans Administration |
$114.84
|
| Rate for Payer: United Healthcare Commercial |
$172.26
|
| Rate for Payer: United Healthcare Medicare |
$114.84
|
| Rate for Payer: WINHealth Partners Commercial |
$194.04
|
| Rate for Payer: Wise Provider Network Commercial |
$188.10
|
|
|
HC CIRCUMCISION NEONATE
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
5105416001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.84
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.43
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.32
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$84.85
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$89.32
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC CIRCUMCISION NEONATE
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
5105416001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.84
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.43
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.64
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$96.56
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$101.64
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$101.64
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
5105415001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.74
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$56.75
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.74
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$59.74
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
5105415001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.98
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$64.58
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.98
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$67.98
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| 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 CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| 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 CLOSED TREATMENT COCCYGEAL FRACTURE
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
5102720001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.89 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$128.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$186.24
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.27
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.52
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$106.89
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.52
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$112.52
|
| Rate for Payer: WINHealth Partners Commercial |
$190.12
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC CLOSED TREATMENT COCCYGEAL FRACTURE
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
5102720001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.64 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$186.24
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.27
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.04
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$121.64
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.04
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$128.04
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
5102776701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.08
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$55.18
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.08
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Medicare |
$58.08
|
| Rate for Payer: WINHealth Partners Commercial |
$83.60
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
|
|
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
5102776701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Aetna of WY Medicare |
$58.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.04
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$48.49
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.04
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Medicare |
$51.04
|
| Rate for Payer: WINHealth Partners Commercial |
$86.24
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
|
|
HC CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
5102565001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
5102565001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
5102722201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$579.35 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$905.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$887.04
|
| Rate for Payer: Altius Commercial |
$887.04
|
| Rate for Payer: Beech Street Commercial |
$905.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$758.60
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$896.28
|
| Rate for Payer: Cigna of WY Commercial |
$905.52
|
| Rate for Payer: Entrust Commercial |
$877.80
|
| Rate for Payer: First Choice Health Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.84
|
| Rate for Payer: HealthUtah PPO |
$924.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$896.28
|
| Rate for Payer: Multiplan Medicare/VA |
$579.35
|
| Rate for Payer: One Health Plan of WY PPO |
$905.52
|
| Rate for Payer: PacificSource Commercial |
$831.60
|
| Rate for Payer: PHCS PPO |
$905.52
|
| Rate for Payer: Three Rivers PPO |
$693.00
|
| Rate for Payer: TriWest Veterans Administration |
$609.84
|
| Rate for Payer: United Healthcare Commercial |
$803.88
|
| Rate for Payer: United Healthcare Medicare |
$609.84
|
| Rate for Payer: WINHealth Partners Commercial |
$877.80
|
| Rate for Payer: Wise Provider Network Commercial |
$877.80
|
|
|
HC CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
5102722201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$509.12 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$905.52
|
| Rate for Payer: Aetna of WY Medicare |
$609.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$887.04
|
| Rate for Payer: Altius Commercial |
$887.04
|
| Rate for Payer: Beech Street Commercial |
$905.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$758.60
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$896.28
|
| Rate for Payer: Cigna of WY Commercial |
$905.52
|
| Rate for Payer: Entrust Commercial |
$877.80
|
| Rate for Payer: First Choice Health Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$877.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$535.92
|
| Rate for Payer: HealthUtah PPO |
$924.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$896.28
|
| Rate for Payer: Multiplan Medicare/VA |
$509.12
|
| Rate for Payer: One Health Plan of WY PPO |
$905.52
|
| Rate for Payer: PacificSource Commercial |
$831.60
|
| Rate for Payer: PHCS PPO |
$905.52
|
| Rate for Payer: Three Rivers PPO |
$693.00
|
| Rate for Payer: TriWest Veterans Administration |
$535.92
|
| Rate for Payer: United Healthcare Commercial |
$803.88
|
| Rate for Payer: United Healthcare Medicare |
$535.92
|
| Rate for Payer: WINHealth Partners Commercial |
$905.52
|
| Rate for Payer: Wise Provider Network Commercial |
$877.80
|
|
|
HC CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
7612784201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
7612784201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
5102784001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.79 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$380.24
|
| Rate for Payer: Aetna of WY Medicare |
$256.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$372.48
|
| Rate for Payer: Altius Commercial |
$372.48
|
| Rate for Payer: Beech Street Commercial |
$380.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$318.55
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.36
|
| Rate for Payer: Cigna of WY Commercial |
$380.24
|
| Rate for Payer: Entrust Commercial |
$368.60
|
| Rate for Payer: First Choice Health Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$225.04
|
| Rate for Payer: HealthUtah PPO |
$388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.36
|
| Rate for Payer: Multiplan Medicare/VA |
$213.79
|
| Rate for Payer: One Health Plan of WY PPO |
$380.24
|
| Rate for Payer: PacificSource Commercial |
$349.20
|
| Rate for Payer: PHCS PPO |
$380.24
|
| Rate for Payer: Three Rivers PPO |
$291.00
|
| Rate for Payer: TriWest Veterans Administration |
$225.04
|
| Rate for Payer: United Healthcare Commercial |
$337.56
|
| Rate for Payer: United Healthcare Medicare |
$225.04
|
| Rate for Payer: WINHealth Partners Commercial |
$380.24
|
| Rate for Payer: Wise Provider Network Commercial |
$368.60
|
|
