|
HC DAP PREGNANCY TEST QUALITATIVE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
3000000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC DAP PREGNANCY TEST QUALITATIVE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
3000000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC DAP PROTIME/INR
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
3000000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$13.78
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$14.50
|
| Rate for Payer: WINHealth Partners Commercial |
$24.50
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC DAP PROTIME/INR
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
3000000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$15.68
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$16.50
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC DAP PSA
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
3000000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.38
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$26.96
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.38
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$28.38
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC DAP PSA
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
3000000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.69
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC DAP TSH
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP TSH
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP URIC ACID
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
3000000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$14.42
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC DAP URIC ACID
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
3000000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC DAP URINALYSIS
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP URINALYSIS
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP VENIPUNCTURE
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP VENIPUNCTURE
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP VITAMIN D-25 HYDROXY
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DAP VITAMIN D-25 HYDROXY
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC DA VINCI ROBOT PROCEDURE
|
Facility
|
OP
|
$1,015.00
|
|
| Hospital Charge Code |
3600000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$559.26 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$974.40
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$833.32
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$588.70
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$559.26
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$588.70
|
| Rate for Payer: United Healthcare Commercial |
$883.05
|
| Rate for Payer: United Healthcare Medicare |
$588.70
|
| Rate for Payer: WINHealth Partners Commercial |
$994.70
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
HC DA VINCI ROBOT PROCEDURE
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
3600000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$636.40 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$974.40
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$833.32
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$636.40
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$883.05
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$964.25
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
HC DBL CONTRAST X-RAY, ESOPHAGUS - RADIOLOGY
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
3207422101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$598.78 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$935.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$916.80
|
| Rate for Payer: Altius Commercial |
$916.80
|
| Rate for Payer: Beech Street Commercial |
$935.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$784.06
|
| Rate for Payer: Cash Price |
$668.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$926.35
|
| Rate for Payer: Cigna of WY Commercial |
$935.90
|
| Rate for Payer: Entrust Commercial |
$907.25
|
| Rate for Payer: First Choice Health Commercial |
$907.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$907.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$630.30
|
| Rate for Payer: HealthUtah PPO |
$955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$926.35
|
| Rate for Payer: Multiplan Medicare/VA |
$598.78
|
| Rate for Payer: One Health Plan of WY PPO |
$935.90
|
| Rate for Payer: PacificSource Commercial |
$859.50
|
| Rate for Payer: PHCS PPO |
$935.90
|
| Rate for Payer: Three Rivers PPO |
$716.25
|
| Rate for Payer: TriWest Veterans Administration |
$630.30
|
| Rate for Payer: United Healthcare Commercial |
$830.85
|
| Rate for Payer: United Healthcare Medicare |
$630.30
|
| Rate for Payer: WINHealth Partners Commercial |
$907.25
|
| Rate for Payer: Wise Provider Network Commercial |
$907.25
|
|
|
HC DBL CONTRAST X-RAY, ESOPHAGUS - RADIOLOGY
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 74221
|
| Hospital Charge Code |
3207422101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$526.20 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$935.90
|
| Rate for Payer: Aetna of WY Medicare |
$630.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$916.80
|
| Rate for Payer: Altius Commercial |
$916.80
|
| Rate for Payer: Beech Street Commercial |
$935.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$784.06
|
| Rate for Payer: Cash Price |
$668.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$926.35
|
| Rate for Payer: Cigna of WY Commercial |
$935.90
|
| Rate for Payer: Entrust Commercial |
$907.25
|
| Rate for Payer: First Choice Health Commercial |
$907.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$907.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$553.90
|
| Rate for Payer: HealthUtah PPO |
$955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$926.35
|
| Rate for Payer: Multiplan Medicare/VA |
$526.20
|
| Rate for Payer: One Health Plan of WY PPO |
$935.90
|
| Rate for Payer: PacificSource Commercial |
$859.50
|
| Rate for Payer: PHCS PPO |
$935.90
|
| Rate for Payer: Three Rivers PPO |
$716.25
|
| Rate for Payer: TriWest Veterans Administration |
$553.90
|
| Rate for Payer: United Healthcare Commercial |
$830.85
|
| Rate for Payer: United Healthcare Medicare |
$553.90
|
| Rate for Payer: WINHealth Partners Commercial |
$935.90
|
| Rate for Payer: Wise Provider Network Commercial |
$907.25
|
|
|
HC DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 11012
|
| Hospital Charge Code |
5101101201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.52 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$440.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$431.04
|
| Rate for Payer: Altius Commercial |
$431.04
|
| Rate for Payer: Beech Street Commercial |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$368.63
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$435.53
|
| Rate for Payer: Cigna of WY Commercial |
$440.02
|
| Rate for Payer: Entrust Commercial |
$426.55
|
| Rate for Payer: First Choice Health Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$296.34
|
| Rate for Payer: HealthUtah PPO |
$449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$435.53
|
| Rate for Payer: Multiplan Medicare/VA |
$281.52
|
| Rate for Payer: One Health Plan of WY PPO |
$440.02
|
| Rate for Payer: PacificSource Commercial |
$404.10
|
| Rate for Payer: PHCS PPO |
$440.02
|
| Rate for Payer: Three Rivers PPO |
$336.75
|
| Rate for Payer: TriWest Veterans Administration |
$296.34
|
| Rate for Payer: United Healthcare Commercial |
$390.63
|
| Rate for Payer: United Healthcare Medicare |
$296.34
|
| Rate for Payer: WINHealth Partners Commercial |
$426.55
|
| Rate for Payer: Wise Provider Network Commercial |
$426.55
|
|
|
HC DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 11012
|
| Hospital Charge Code |
5101101201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$247.40 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$440.02
|
| Rate for Payer: Aetna of WY Medicare |
$296.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$431.04
|
| Rate for Payer: Altius Commercial |
$431.04
|
| Rate for Payer: Beech Street Commercial |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$368.63
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$435.53
|
| Rate for Payer: Cigna of WY Commercial |
$440.02
|
| Rate for Payer: Entrust Commercial |
$426.55
|
| Rate for Payer: First Choice Health Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.42
|
| Rate for Payer: HealthUtah PPO |
$449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$435.53
|
| Rate for Payer: Multiplan Medicare/VA |
$247.40
|
| Rate for Payer: One Health Plan of WY PPO |
$440.02
|
| Rate for Payer: PacificSource Commercial |
$404.10
|
| Rate for Payer: PHCS PPO |
$440.02
|
| Rate for Payer: Three Rivers PPO |
$336.75
|
| Rate for Payer: TriWest Veterans Administration |
$260.42
|
| Rate for Payer: United Healthcare Commercial |
$390.63
|
| Rate for Payer: United Healthcare Medicare |
$260.42
|
| Rate for Payer: WINHealth Partners Commercial |
$440.02
|
| Rate for Payer: Wise Provider Network Commercial |
$426.55
|
|
|
HC DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5101101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.68 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$265.92
|
| Rate for Payer: Altius Commercial |
$265.92
|
| Rate for Payer: Beech Street Commercial |
$271.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.42
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: Entrust Commercial |
$263.15
|
| Rate for Payer: First Choice Health Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.82
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$173.68
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$271.46
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$182.82
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$182.82
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
| Rate for Payer: Wise Provider Network Commercial |
$263.15
|
|
|
HC DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5101101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.63 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$182.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$265.92
|
| Rate for Payer: Altius Commercial |
$265.92
|
| Rate for Payer: Beech Street Commercial |
$271.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.42
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: Entrust Commercial |
$263.15
|
| Rate for Payer: First Choice Health Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.66
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$152.63
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$271.46
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$160.66
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$160.66
|
| Rate for Payer: WINHealth Partners Commercial |
$271.46
|
| Rate for Payer: Wise Provider Network Commercial |
$263.15
|
|
|
HC DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
5101101101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.73 |
| Max. Negotiated Rate |
$301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.96
|
| Rate for Payer: Altius Commercial |
$288.96
|
| Rate for Payer: Beech Street Commercial |
$294.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.12
|
| Rate for Payer: Cash Price |
$210.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.97
|
| Rate for Payer: Cigna of WY Commercial |
$294.98
|
| Rate for Payer: Entrust Commercial |
$285.95
|
| Rate for Payer: First Choice Health Commercial |
$285.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.66
|
| Rate for Payer: HealthUtah PPO |
$301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.97
|
| Rate for Payer: Multiplan Medicare/VA |
$188.73
|
| Rate for Payer: One Health Plan of WY PPO |
$294.98
|
| Rate for Payer: PacificSource Commercial |
$270.90
|
| Rate for Payer: PHCS PPO |
$294.98
|
| Rate for Payer: Three Rivers PPO |
$225.75
|
| Rate for Payer: TriWest Veterans Administration |
$198.66
|
| Rate for Payer: United Healthcare Commercial |
$261.87
|
| Rate for Payer: United Healthcare Medicare |
$198.66
|
| Rate for Payer: WINHealth Partners Commercial |
$285.95
|
| Rate for Payer: Wise Provider Network Commercial |
$285.95
|
|
