|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
IP
|
$2,222.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4024908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,287.65 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,177.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,422.08
|
| Rate for Payer: Altius Commercial |
$2,133.12
|
| Rate for Payer: Beech Street Commercial |
$2,177.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,155.34
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,155.34
|
| Rate for Payer: Cigna of WY Commercial |
$2,177.56
|
| Rate for Payer: Entrust Commercial |
$2,110.90
|
| Rate for Payer: First Choice Health Commercial |
$2,110.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,110.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,355.42
|
| Rate for Payer: HealthUtah PPO |
$2,222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,155.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1,287.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,177.56
|
| Rate for Payer: PacificSource Commercial |
$1,999.80
|
| Rate for Payer: PHCS PPO |
$2,177.56
|
| Rate for Payer: Three Rivers PPO |
$1,666.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,355.42
|
| Rate for Payer: United Healthcare Commercial |
$2,122.01
|
| Rate for Payer: United Healthcare Medicare |
$1,355.42
|
| Rate for Payer: WINHealth Partners Commercial |
$2,110.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,110.90
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
7614908301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.64 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$381.22
|
| Rate for Payer: Aetna of WY Medicare |
$256.74
|
| Rate for Payer: Altius Commercial |
$373.44
|
| Rate for Payer: Beech Street Commercial |
$381.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.33
|
| Rate for Payer: Cash Price |
$272.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$377.33
|
| Rate for Payer: Cigna of WY Commercial |
$381.22
|
| Rate for Payer: Entrust Commercial |
$369.55
|
| Rate for Payer: First Choice Health Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.73
|
| Rate for Payer: HealthUtah PPO |
$389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$377.33
|
| Rate for Payer: Multiplan Medicare/VA |
$210.64
|
| Rate for Payer: One Health Plan of WY PPO |
$381.22
|
| Rate for Payer: PacificSource Commercial |
$350.10
|
| Rate for Payer: PHCS PPO |
$381.22
|
| Rate for Payer: Three Rivers PPO |
$291.75
|
| Rate for Payer: TriWest Veterans Administration |
$221.73
|
| Rate for Payer: United Healthcare Commercial |
$371.50
|
| Rate for Payer: United Healthcare Medicare |
$221.73
|
| Rate for Payer: WINHealth Partners Commercial |
$381.22
|
| Rate for Payer: Wise Provider Network Commercial |
$369.55
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
7614908301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.43 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$381.22
|
| Rate for Payer: Aetna of WY Medicare |
$248.96
|
| Rate for Payer: Altius Commercial |
$373.44
|
| Rate for Payer: Beech Street Commercial |
$381.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.33
|
| Rate for Payer: Cash Price |
$272.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$377.33
|
| Rate for Payer: Cigna of WY Commercial |
$381.22
|
| Rate for Payer: Entrust Commercial |
$369.55
|
| Rate for Payer: First Choice Health Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.29
|
| Rate for Payer: HealthUtah PPO |
$389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$377.33
|
| Rate for Payer: Multiplan Medicare/VA |
$225.43
|
| Rate for Payer: One Health Plan of WY PPO |
$381.22
|
| Rate for Payer: PacificSource Commercial |
$350.10
|
| Rate for Payer: PHCS PPO |
$381.22
|
| Rate for Payer: Three Rivers PPO |
$291.75
|
| Rate for Payer: TriWest Veterans Administration |
$237.29
|
| Rate for Payer: United Healthcare Commercial |
$371.50
|
| Rate for Payer: United Healthcare Medicare |
$237.29
|
| Rate for Payer: WINHealth Partners Commercial |
$369.55
|
| Rate for Payer: Wise Provider Network Commercial |
$369.55
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.49 |
| 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 Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.20
|
| 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 |
$34.20
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$32.49
|
| 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 |
$34.20
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Medicare |
$34.20
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
5104908201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$38.40
|
| 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 |
$58.20
|
| 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 |
$36.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$34.77
|
| 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 |
$36.60
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.43 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$381.22
|
| Rate for Payer: Aetna of WY Medicare |
$248.96
|
| Rate for Payer: Altius Commercial |
$373.44
|
| Rate for Payer: Beech Street Commercial |
$381.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.33
|
| Rate for Payer: Cash Price |
$272.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$377.33
|
| Rate for Payer: Cigna of WY Commercial |
$381.22
|
| Rate for Payer: Entrust Commercial |
$369.55
|
| Rate for Payer: First Choice Health Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.29
|
| Rate for Payer: HealthUtah PPO |
$389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$377.33
|
| Rate for Payer: Multiplan Medicare/VA |
$225.43
|
| Rate for Payer: One Health Plan of WY PPO |
$381.22
|
| Rate for Payer: PacificSource Commercial |
$350.10
|
| Rate for Payer: PHCS PPO |
$381.22
|
| Rate for Payer: Three Rivers PPO |
$291.75
|
| Rate for Payer: TriWest Veterans Administration |
$237.29
|
| Rate for Payer: United Healthcare Commercial |
$371.50
|
| Rate for Payer: United Healthcare Medicare |
$237.29
|
| Rate for Payer: WINHealth Partners Commercial |
$369.55
|
| Rate for Payer: Wise Provider Network Commercial |
$369.55
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.64 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$381.22
|
| Rate for Payer: Aetna of WY Medicare |
$256.74
|
| Rate for Payer: Altius Commercial |
$373.44
|
| Rate for Payer: Beech Street Commercial |
$381.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.33
|
| Rate for Payer: Cash Price |
$272.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$377.33
|
| Rate for Payer: Cigna of WY Commercial |
$381.22
|
| Rate for Payer: Entrust Commercial |
$369.55
|
| Rate for Payer: First Choice Health Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$369.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.73
|
| Rate for Payer: HealthUtah PPO |
$389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$377.33
|
| Rate for Payer: Multiplan Medicare/VA |
$210.64
|
| Rate for Payer: One Health Plan of WY PPO |
$381.22
|
| Rate for Payer: PacificSource Commercial |
$350.10
|
| Rate for Payer: PHCS PPO |
$381.22
|
| Rate for Payer: Three Rivers PPO |
$291.75
|
| Rate for Payer: TriWest Veterans Administration |
$221.73
|
| Rate for Payer: United Healthcare Commercial |
$371.50
|
| Rate for Payer: United Healthcare Medicare |
$221.73
|
| Rate for Payer: WINHealth Partners Commercial |
$381.22
|
| Rate for Payer: Wise Provider Network Commercial |
$369.55
|
|
|
HC ACNE SURGERY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
5101004001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.74
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.94
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$22.74
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$23.94
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$23.94
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC ACNE SURGERY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
5101004001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$26.88
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.74
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.62
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$25.62
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Aetna of WY Medicare |
$23.76
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.52
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$19.49
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.52
|
| Rate for Payer: United Healthcare Commercial |
$34.38
|
| Rate for Payer: United Healthcare Medicare |
$20.52
|
| Rate for Payer: WINHealth Partners Commercial |
$35.28
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Aetna of WY Medicare |
$23.04
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.96
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$20.86
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$21.96
|
| Rate for Payer: United Healthcare Commercial |
$34.38
|
| Rate for Payer: United Healthcare Medicare |
$21.96
|
| Rate for Payer: WINHealth Partners Commercial |
$34.20
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
3058530701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$81.84
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.68
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$67.15
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.68
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$70.68
|
| Rate for Payer: WINHealth Partners Commercial |
$121.52
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
3058530701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$79.36
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.64
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$71.86
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$75.64
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$75.64
|
| Rate for Payer: WINHealth Partners Commercial |
$117.80
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$529.59 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$958.44
|
| Rate for Payer: Aetna of WY Medicare |
$645.48
|
| Rate for Payer: Altius Commercial |
$938.88
|
| Rate for Payer: Beech Street Commercial |
$958.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.66
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$948.66
|
| Rate for Payer: Cigna of WY Commercial |
$958.44
|
| Rate for Payer: Entrust Commercial |
$929.10
|
| Rate for Payer: First Choice Health Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$557.46
|
| Rate for Payer: HealthUtah PPO |
$978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$948.66
|
| Rate for Payer: Multiplan Medicare/VA |
$529.59
|
| Rate for Payer: One Health Plan of WY PPO |
$958.44
|
| Rate for Payer: PacificSource Commercial |
$880.20
|
| Rate for Payer: PHCS PPO |
$958.44
|
| Rate for Payer: Three Rivers PPO |
$733.50
|
| Rate for Payer: TriWest Veterans Administration |
$557.46
|
| Rate for Payer: United Healthcare Commercial |
$933.99
|
| Rate for Payer: United Healthcare Medicare |
$557.46
|
| Rate for Payer: WINHealth Partners Commercial |
$958.44
|
| Rate for Payer: Wise Provider Network Commercial |
$929.10
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$566.75 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$958.44
|
| Rate for Payer: Aetna of WY Medicare |
$625.92
|
| Rate for Payer: Altius Commercial |
$938.88
|
| Rate for Payer: Beech Street Commercial |
$958.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.66
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$948.66
|
| Rate for Payer: Cigna of WY Commercial |
$958.44
|
| Rate for Payer: Entrust Commercial |
$929.10
|
| Rate for Payer: First Choice Health Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$929.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$596.58
|
| Rate for Payer: HealthUtah PPO |
$978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$948.66
|
| Rate for Payer: Multiplan Medicare/VA |
$566.75
|
| Rate for Payer: One Health Plan of WY PPO |
$958.44
|
| Rate for Payer: PacificSource Commercial |
$880.20
|
| Rate for Payer: PHCS PPO |
$958.44
|
| Rate for Payer: Three Rivers PPO |
$733.50
|
| Rate for Payer: TriWest Veterans Administration |
$596.58
|
| Rate for Payer: United Healthcare Commercial |
$933.99
|
| Rate for Payer: United Healthcare Medicare |
$596.58
|
| Rate for Payer: WINHealth Partners Commercial |
$929.10
|
| Rate for Payer: Wise Provider Network Commercial |
$929.10
|
|
|
HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES, PLASMA, QUANT
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
3018201701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$224.27 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$247.68
|
| Rate for Payer: Altius Commercial |
$371.52
|
| Rate for Payer: Beech Street Commercial |
$379.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$375.39
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: Entrust Commercial |
$367.65
|
| Rate for Payer: First Choice Health Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$236.07
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$224.27
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$379.26
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$236.07
|
| Rate for Payer: United Healthcare Commercial |
$369.58
|
| Rate for Payer: United Healthcare Medicare |
$236.07
|
| Rate for Payer: WINHealth Partners Commercial |
$367.65
|
| Rate for Payer: Wise Provider Network Commercial |
$367.65
|
|
|
HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES, PLASMA, QUANT
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
3018201701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$255.42
|
| Rate for Payer: Altius Commercial |
$371.52
|
| Rate for Payer: Beech Street Commercial |
$379.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$375.39
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: Entrust Commercial |
$367.65
|
| Rate for Payer: First Choice Health Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.59
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$209.56
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$379.26
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$220.59
|
| Rate for Payer: United Healthcare Commercial |
$369.58
|
| Rate for Payer: United Healthcare Medicare |
$220.59
|
| Rate for Payer: WINHealth Partners Commercial |
$379.26
|
| Rate for Payer: Wise Provider Network Commercial |
$367.65
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$70.40
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$63.74
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ADENOVIRUS DNA QN
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$434.62 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Aetna of WY Medicare |
$480.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$727.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$457.50
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$434.62
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$457.50
|
| Rate for Payer: United Healthcare Commercial |
$716.25
|
| Rate for Payer: United Healthcare Medicare |
$457.50
|
| Rate for Payer: WINHealth Partners Commercial |
$712.50
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC ADENOVIRUS DNA QN
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$406.12 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Aetna of WY Medicare |
$495.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$727.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.50
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$406.12
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$427.50
|
| Rate for Payer: United Healthcare Commercial |
$716.25
|
| Rate for Payer: United Healthcare Medicare |
$427.50
|
| Rate for Payer: WINHealth Partners Commercial |
$735.00
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
5101402001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.18 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Aetna of WY Medicare |
$289.08
|
| Rate for Payer: Altius Commercial |
$420.48
|
| Rate for Payer: Beech Street Commercial |
$429.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.86
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: Entrust Commercial |
$416.10
|
| Rate for Payer: First Choice Health Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.66
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$237.18
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$429.24
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.66
|
| Rate for Payer: United Healthcare Commercial |
$418.29
|
| Rate for Payer: United Healthcare Medicare |
$249.66
|
| Rate for Payer: WINHealth Partners Commercial |
$429.24
|
| Rate for Payer: Wise Provider Network Commercial |
$416.10
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
5101402001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Aetna of WY Medicare |
$280.32
|
| Rate for Payer: Altius Commercial |
$420.48
|
| Rate for Payer: Beech Street Commercial |
$429.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.86
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: Entrust Commercial |
$416.10
|
| Rate for Payer: First Choice Health Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.18
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$253.82
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$429.24
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$267.18
|
| Rate for Payer: United Healthcare Commercial |
$418.29
|
| Rate for Payer: United Healthcare Medicare |
$267.18
|
| Rate for Payer: WINHealth Partners Commercial |
$416.10
|
| Rate for Payer: Wise Provider Network Commercial |
$416.10
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
7611404001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$367.36
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.14
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$332.63
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.14
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$350.14
|
| Rate for Payer: WINHealth Partners Commercial |
$545.30
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
HC ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
7611404001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.82 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$378.84
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.18
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$310.82
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$327.18
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$327.18
|
| Rate for Payer: WINHealth Partners Commercial |
$562.52
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
