|
HC AMINO ACIDS, SINGLE QUANTITATION - TRYPTOPHAN PLASMA
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$131.34
|
| Rate for Payer: Altius Commercial |
$191.04
|
| Rate for Payer: Beech Street Commercial |
$195.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.03
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: Entrust Commercial |
$189.05
|
| Rate for Payer: First Choice Health Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.43
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$107.76
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$195.02
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.43
|
| Rate for Payer: United Healthcare Commercial |
$190.04
|
| Rate for Payer: United Healthcare Medicare |
$113.43
|
| Rate for Payer: WINHealth Partners Commercial |
$195.02
|
| Rate for Payer: Wise Provider Network Commercial |
$189.05
|
|
|
HC AMNIOCENTESIS,DIAGNOSTIC
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
4025900001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,378.27 |
| Max. Negotiated Rate |
$4,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,021.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,626.56
|
| Rate for Payer: Altius Commercial |
$3,939.84
|
| Rate for Payer: Beech Street Commercial |
$4,021.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,980.88
|
| Rate for Payer: Cash Price |
$2,872.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,980.88
|
| Rate for Payer: Cigna of WY Commercial |
$4,021.92
|
| Rate for Payer: Entrust Commercial |
$3,898.80
|
| Rate for Payer: First Choice Health Commercial |
$3,898.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,898.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,503.44
|
| Rate for Payer: HealthUtah PPO |
$4,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,980.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2,378.27
|
| Rate for Payer: One Health Plan of WY PPO |
$4,021.92
|
| Rate for Payer: PacificSource Commercial |
$3,693.60
|
| Rate for Payer: PHCS PPO |
$4,021.92
|
| Rate for Payer: Three Rivers PPO |
$3,078.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,503.44
|
| Rate for Payer: United Healthcare Commercial |
$3,919.32
|
| Rate for Payer: United Healthcare Medicare |
$2,503.44
|
| Rate for Payer: WINHealth Partners Commercial |
$3,898.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3,898.80
|
|
|
HC AMNIOCENTESIS,DIAGNOSTIC
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
4025900001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,222.32 |
| Max. Negotiated Rate |
$4,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,021.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,708.64
|
| Rate for Payer: Altius Commercial |
$3,939.84
|
| Rate for Payer: Beech Street Commercial |
$4,021.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,980.88
|
| Rate for Payer: Cash Price |
$2,872.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,980.88
|
| Rate for Payer: Cigna of WY Commercial |
$4,021.92
|
| Rate for Payer: Entrust Commercial |
$3,898.80
|
| Rate for Payer: First Choice Health Commercial |
$3,898.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,898.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,339.28
|
| Rate for Payer: HealthUtah PPO |
$4,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,980.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2,222.32
|
| Rate for Payer: One Health Plan of WY PPO |
$4,021.92
|
| Rate for Payer: PacificSource Commercial |
$3,693.60
|
| Rate for Payer: PHCS PPO |
$4,021.92
|
| Rate for Payer: Three Rivers PPO |
$3,078.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,339.28
|
| Rate for Payer: United Healthcare Commercial |
$3,919.32
|
| Rate for Payer: United Healthcare Medicare |
$2,339.28
|
| Rate for Payer: WINHealth Partners Commercial |
$4,021.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3,898.80
|
|
|
HC AMPUTATION FINGER/THUMB
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
7612695101
|
|
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 AMPUTATION FINGER/THUMB
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
7612695101
|
|
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
|
|
|
HC ANESTHESIA EPIDURAL BLOCK
|
Facility
|
IP
|
$208.00
|
|
| Hospital Charge Code |
3700000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$133.12
|
| Rate for Payer: Altius Commercial |
$199.68
|
| Rate for Payer: Beech Street Commercial |
$203.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.76
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: Entrust Commercial |
$197.60
|
| Rate for Payer: First Choice Health Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.88
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$120.54
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$203.84
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$126.88
|
| Rate for Payer: United Healthcare Commercial |
$198.64
|
| Rate for Payer: United Healthcare Medicare |
$126.88
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
| Rate for Payer: Wise Provider Network Commercial |
$197.60
|
|
|
HC ANESTHESIA EPIDURAL BLOCK
|
Facility
|
OP
|
$208.00
|
|
| Hospital Charge Code |
3700000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$112.63 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$137.28
|
| Rate for Payer: Altius Commercial |
$199.68
|
| Rate for Payer: Beech Street Commercial |
$203.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.76
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: Entrust Commercial |
$197.60
|
| Rate for Payer: First Choice Health Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.56
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$112.63
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$203.84
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.56
|
| Rate for Payer: United Healthcare Commercial |
$198.64
|
| Rate for Payer: United Healthcare Medicare |
$118.56
|
| Rate for Payer: WINHealth Partners Commercial |
$203.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.60
|
|
|
HC ANESTHESIA ER
|
Facility
|
IP
|
$195.00
|
|
| Hospital Charge Code |
3700000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$124.80
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.15
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.95
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$113.00
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$118.95
|
| Rate for Payer: United Healthcare Commercial |
$186.22
|
| Rate for Payer: United Healthcare Medicare |
$118.95
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC ANESTHESIA ER
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
3700000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$105.59 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.15
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.15
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$105.59
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$111.15
|
| Rate for Payer: United Healthcare Commercial |
$186.22
|
| Rate for Payer: United Healthcare Medicare |
$111.15
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC ANESTHESIA GENERAL SET UP
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$479.83 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$811.44
|
| Rate for Payer: Aetna of WY Medicare |
$529.92
|
| Rate for Payer: Altius Commercial |
$794.88
|
| Rate for Payer: Beech Street Commercial |
$811.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$803.16
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$803.16
|
| Rate for Payer: Cigna of WY Commercial |
$811.44
|
| Rate for Payer: Entrust Commercial |
$786.60
|
| Rate for Payer: First Choice Health Commercial |
$786.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$786.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$505.08
|
| Rate for Payer: HealthUtah PPO |
$828.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$803.16
|
| Rate for Payer: Multiplan Medicare/VA |
$479.83
|
| Rate for Payer: One Health Plan of WY PPO |
$811.44
|
| Rate for Payer: PacificSource Commercial |
$745.20
|
| Rate for Payer: PHCS PPO |
$811.44
|
| Rate for Payer: Three Rivers PPO |
$621.00
|
| Rate for Payer: TriWest Veterans Administration |
$505.08
|
| Rate for Payer: United Healthcare Commercial |
$790.74
|
| Rate for Payer: United Healthcare Medicare |
$505.08
|
| Rate for Payer: WINHealth Partners Commercial |
$786.60
|
| Rate for Payer: Wise Provider Network Commercial |
$786.60
|
|
|
HC ANESTHESIA GENERAL SET UP
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
3700000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$448.36 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$811.44
|
| Rate for Payer: Aetna of WY Medicare |
$546.48
|
| Rate for Payer: Altius Commercial |
$794.88
|
| Rate for Payer: Beech Street Commercial |
$811.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$803.16
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$803.16
|
| Rate for Payer: Cigna of WY Commercial |
$811.44
|
| Rate for Payer: Entrust Commercial |
$786.60
|
| Rate for Payer: First Choice Health Commercial |
$786.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$786.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.96
|
| Rate for Payer: HealthUtah PPO |
$828.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$803.16
|
| Rate for Payer: Multiplan Medicare/VA |
$448.36
|
| Rate for Payer: One Health Plan of WY PPO |
$811.44
|
| Rate for Payer: PacificSource Commercial |
$745.20
|
| Rate for Payer: PHCS PPO |
$811.44
|
| Rate for Payer: Three Rivers PPO |
$621.00
|
| Rate for Payer: TriWest Veterans Administration |
$471.96
|
| Rate for Payer: United Healthcare Commercial |
$790.74
|
| Rate for Payer: United Healthcare Medicare |
$471.96
|
| Rate for Payer: WINHealth Partners Commercial |
$811.44
|
| Rate for Payer: Wise Provider Network Commercial |
$786.60
|
|
|
HC ANESTHESIA LEVEL - MAC
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
3700000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$101.12
|
| Rate for Payer: Altius Commercial |
$151.68
|
| Rate for Payer: Beech Street Commercial |
$154.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.26
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: Entrust Commercial |
$150.10
|
| Rate for Payer: First Choice Health Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.38
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$91.56
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$154.84
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.38
|
| Rate for Payer: United Healthcare Commercial |
$150.89
|
| Rate for Payer: United Healthcare Medicare |
$96.38
|
| Rate for Payer: WINHealth Partners Commercial |
$150.10
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
|
HC ANESTHESIA LEVEL - MAC
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
3700000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$85.56 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$104.28
|
| Rate for Payer: Altius Commercial |
$151.68
|
| Rate for Payer: Beech Street Commercial |
$154.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.26
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: Entrust Commercial |
$150.10
|
| Rate for Payer: First Choice Health Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.06
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$85.56
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$154.84
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$90.06
|
| Rate for Payer: United Healthcare Commercial |
$150.89
|
| Rate for Payer: United Healthcare Medicare |
$90.06
|
| Rate for Payer: WINHealth Partners Commercial |
$154.84
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
|
HC ANESTHESIA SUPPLY ANESTH
|
Facility
|
IP
|
$572.00
|
|
| Hospital Charge Code |
3700000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$331.47 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.56
|
| Rate for Payer: Aetna of WY Medicare |
$366.08
|
| Rate for Payer: Altius Commercial |
$549.12
|
| Rate for Payer: Beech Street Commercial |
$560.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$554.84
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$554.84
|
| Rate for Payer: Cigna of WY Commercial |
$560.56
|
| Rate for Payer: Entrust Commercial |
$543.40
|
| Rate for Payer: First Choice Health Commercial |
$543.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.92
|
| Rate for Payer: HealthUtah PPO |
$572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$554.84
|
| Rate for Payer: Multiplan Medicare/VA |
$331.47
|
| Rate for Payer: One Health Plan of WY PPO |
$560.56
|
| Rate for Payer: PacificSource Commercial |
$514.80
|
| Rate for Payer: PHCS PPO |
$560.56
|
| Rate for Payer: Three Rivers PPO |
$429.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.92
|
| Rate for Payer: United Healthcare Commercial |
$546.26
|
| Rate for Payer: United Healthcare Medicare |
$348.92
|
| Rate for Payer: WINHealth Partners Commercial |
$543.40
|
| Rate for Payer: Wise Provider Network Commercial |
$543.40
|
|
|
HC ANESTHESIA SUPPLY ANESTH
|
Facility
|
OP
|
$572.00
|
|
| Hospital Charge Code |
3700000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$309.74 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.56
|
| Rate for Payer: Aetna of WY Medicare |
$377.52
|
| Rate for Payer: Altius Commercial |
$549.12
|
| Rate for Payer: Beech Street Commercial |
$560.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$554.84
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$554.84
|
| Rate for Payer: Cigna of WY Commercial |
$560.56
|
| Rate for Payer: Entrust Commercial |
$543.40
|
| Rate for Payer: First Choice Health Commercial |
$543.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.04
|
| Rate for Payer: HealthUtah PPO |
$572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$554.84
|
| Rate for Payer: Multiplan Medicare/VA |
$309.74
|
| Rate for Payer: One Health Plan of WY PPO |
$560.56
|
| Rate for Payer: PacificSource Commercial |
$514.80
|
| Rate for Payer: PHCS PPO |
$560.56
|
| Rate for Payer: Three Rivers PPO |
$429.00
|
| Rate for Payer: TriWest Veterans Administration |
$326.04
|
| Rate for Payer: United Healthcare Commercial |
$546.26
|
| Rate for Payer: United Healthcare Medicare |
$326.04
|
| Rate for Payer: WINHealth Partners Commercial |
$560.56
|
| Rate for Payer: Wise Provider Network Commercial |
$543.40
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.31 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.44
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.64
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$82.31
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$86.64
|
| Rate for Payer: United Healthcare Commercial |
$145.16
|
| Rate for Payer: United Healthcare Medicare |
$86.64
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$97.28
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.44
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.72
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$88.08
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.72
|
| Rate for Payer: United Healthcare Commercial |
$145.16
|
| Rate for Payer: United Healthcare Medicare |
$92.72
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC ANNUAL DEPRESSION SCREENING EA 15 MIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
510G044401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$29.44
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.06
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$26.66
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$28.06
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$28.06
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC ANNUAL DEPRESSION SCREENING EA 15 MIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
510G044401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$30.36
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.22
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$24.91
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.22
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$26.22
|
| Rate for Payer: WINHealth Partners Commercial |
$45.08
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC ANNUAL WELLNESS PPPS, INITIAL VISIT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
510G043801
|
|
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 ANNUAL WELLNESS PPPS, INITIAL VISIT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
510G043801
|
|
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 ANNUAL WELLNESS PPPS, SUBSEQUENT VISIT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
510G043901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.08
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.86
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.66
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.58
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$21.66
|
| Rate for Payer: United Healthcare Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicare |
$21.66
|
| Rate for Payer: WINHealth Partners Commercial |
$37.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC ANNUAL WELLNESS PPPS, SUBSEQUENT VISIT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
510G043901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$24.32
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.86
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.18
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$22.02
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$23.18
|
| Rate for Payer: United Healthcare Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicare |
$23.18
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
