|
HC FLUORESCENT ANTIBODY; TITER - AMINO 3-H-5-M-4 ISOXAZOLEPROP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625605
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - CONTACTIN-ASSOCIATED PROTEIN 2
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625611
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - CONTACTIN-ASSOCIATED PROTEIN 2
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625611
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - GAMMA AMINOBUTYRIC ACID RECEPT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625606
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - GAMMA AMINOBUTYRIC ACID RECEPT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625606
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - LEUCINE GLIOMA-INACTIVED PROTE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - LEUCINE GLIOMA-INACTIVED PROTE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625608
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - N-METHYL-D-ASPARTATE RECEPTOR
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625604
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - N-METHYL-D-ASPARTATE RECEPTOR
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625604
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC FLUORESCENT ANTIBODY; TITER - PHOSPHOLIPASE A2 ANTIBODY TITE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625610
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC FLUORESCENT ANTIBODY; TITER - PHOSPHOLIPASE A2 ANTIBODY TITE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625610
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$628.14 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.20
|
| Rate for Payer: Aetna of WY Medicare |
$752.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,094.40
|
| Rate for Payer: Altius Commercial |
$1,094.40
|
| Rate for Payer: Beech Street Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.94
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,105.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.20
|
| Rate for Payer: Entrust Commercial |
$1,083.00
|
| Rate for Payer: First Choice Health Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.20
|
| Rate for Payer: HealthUtah PPO |
$1,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,105.80
|
| Rate for Payer: Multiplan Medicare/VA |
$628.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.20
|
| Rate for Payer: PacificSource Commercial |
$1,026.00
|
| Rate for Payer: PHCS PPO |
$1,117.20
|
| Rate for Payer: Three Rivers PPO |
$855.00
|
| Rate for Payer: TriWest Veterans Administration |
$661.20
|
| Rate for Payer: United Healthcare Commercial |
$991.80
|
| Rate for Payer: United Healthcare Medicare |
$661.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,117.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.00
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$714.78 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,094.40
|
| Rate for Payer: Altius Commercial |
$1,094.40
|
| Rate for Payer: Beech Street Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.94
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,105.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.20
|
| Rate for Payer: Entrust Commercial |
$1,083.00
|
| Rate for Payer: First Choice Health Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$752.40
|
| Rate for Payer: HealthUtah PPO |
$1,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,105.80
|
| Rate for Payer: Multiplan Medicare/VA |
$714.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.20
|
| Rate for Payer: PacificSource Commercial |
$1,026.00
|
| Rate for Payer: PHCS PPO |
$1,117.20
|
| Rate for Payer: Three Rivers PPO |
$855.00
|
| Rate for Payer: TriWest Veterans Administration |
$752.40
|
| Rate for Payer: United Healthcare Commercial |
$991.80
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,083.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.00
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$628.14 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.20
|
| Rate for Payer: Aetna of WY Medicare |
$752.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,094.40
|
| Rate for Payer: Altius Commercial |
$1,094.40
|
| Rate for Payer: Beech Street Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.94
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,105.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.20
|
| Rate for Payer: Entrust Commercial |
$1,083.00
|
| Rate for Payer: First Choice Health Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.20
|
| Rate for Payer: HealthUtah PPO |
$1,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,105.80
|
| Rate for Payer: Multiplan Medicare/VA |
$628.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.20
|
| Rate for Payer: PacificSource Commercial |
$1,026.00
|
| Rate for Payer: PHCS PPO |
$1,117.20
|
| Rate for Payer: Three Rivers PPO |
$855.00
|
| Rate for Payer: TriWest Veterans Administration |
$661.20
|
| Rate for Payer: United Healthcare Commercial |
$991.80
|
| Rate for Payer: United Healthcare Medicare |
$661.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,117.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.00
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$714.78 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,117.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,094.40
|
| Rate for Payer: Altius Commercial |
$1,094.40
|
| Rate for Payer: Beech Street Commercial |
$1,117.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.94
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,105.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,117.20
|
| Rate for Payer: Entrust Commercial |
$1,083.00
|
| Rate for Payer: First Choice Health Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$752.40
|
| Rate for Payer: HealthUtah PPO |
$1,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,105.80
|
| Rate for Payer: Multiplan Medicare/VA |
$714.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,117.20
|
| Rate for Payer: PacificSource Commercial |
$1,026.00
|
| Rate for Payer: PHCS PPO |
$1,117.20
|
| Rate for Payer: Three Rivers PPO |
$855.00
|
| Rate for Payer: TriWest Veterans Administration |
$752.40
|
| Rate for Payer: United Healthcare Commercial |
$991.80
|
| Rate for Payer: United Healthcare Medicare |
$752.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,083.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,083.00
|
|
|
HC FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
3207700301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
3207700301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.30
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$285.28
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.30
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
5105445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.68
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.62
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$36.37
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Medicare |
$38.28
|
| Rate for Payer: WINHealth Partners Commercial |
$55.10
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
5105445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$38.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.68
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.62
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.64
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$31.96
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Medicare |
$33.64
|
| Rate for Payer: WINHealth Partners Commercial |
$56.84
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC FRACTURE ASSESSMENT VIA DXA - DEXA BONE DENSITY SPINE FRACTURE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 77086
|
| Hospital Charge Code |
3207708601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC FRACTURE ASSESSMENT VIA DXA - DEXA BONE DENSITY SPINE FRACTURE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 77086
|
| Hospital Charge Code |
3207708601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
5103093001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.58
|
| Rate for Payer: Aetna of WY Medicare |
$79.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$116.16
|
| Rate for Payer: Altius Commercial |
$116.16
|
| Rate for Payer: Beech Street Commercial |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.34
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.37
|
| Rate for Payer: Cigna of WY Commercial |
$118.58
|
| Rate for Payer: Entrust Commercial |
$114.95
|
| Rate for Payer: First Choice Health Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.18
|
| Rate for Payer: HealthUtah PPO |
$121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.37
|
| Rate for Payer: Multiplan Medicare/VA |
$66.67
|
| Rate for Payer: One Health Plan of WY PPO |
$118.58
|
| Rate for Payer: PacificSource Commercial |
$108.90
|
| Rate for Payer: PHCS PPO |
$118.58
|
| Rate for Payer: Three Rivers PPO |
$90.75
|
| Rate for Payer: TriWest Veterans Administration |
$70.18
|
| Rate for Payer: United Healthcare Commercial |
$105.27
|
| Rate for Payer: United Healthcare Medicare |
$70.18
|
| Rate for Payer: WINHealth Partners Commercial |
$118.58
|
| Rate for Payer: Wise Provider Network Commercial |
$114.95
|
|
|
HC FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
5103093001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.87 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$116.16
|
| Rate for Payer: Altius Commercial |
$116.16
|
| Rate for Payer: Beech Street Commercial |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.34
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.37
|
| Rate for Payer: Cigna of WY Commercial |
$118.58
|
| Rate for Payer: Entrust Commercial |
$114.95
|
| Rate for Payer: First Choice Health Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.86
|
| Rate for Payer: HealthUtah PPO |
$121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.37
|
| Rate for Payer: Multiplan Medicare/VA |
$75.87
|
| Rate for Payer: One Health Plan of WY PPO |
$118.58
|
| Rate for Payer: PacificSource Commercial |
$108.90
|
| Rate for Payer: PHCS PPO |
$118.58
|
| Rate for Payer: Three Rivers PPO |
$90.75
|
| Rate for Payer: TriWest Veterans Administration |
$79.86
|
| Rate for Payer: United Healthcare Commercial |
$105.27
|
| Rate for Payer: United Healthcare Medicare |
$79.86
|
| Rate for Payer: WINHealth Partners Commercial |
$114.95
|
| Rate for Payer: Wise Provider Network Commercial |
$114.95
|
|
|
HC FRACTURE / THUMB W MANIP
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
7612664101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC FRACTURE / THUMB W MANIP
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
7612664101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
