|
HC GYNECOLOGY PROCEDURE
|
Facility
|
IP
|
$620.00
|
|
| Hospital Charge Code |
3600000042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.74 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$595.20
|
| Rate for Payer: Altius Commercial |
$595.20
|
| Rate for Payer: Beech Street Commercial |
$607.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.02
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
| Rate for Payer: Cigna of WY Commercial |
$607.60
|
| Rate for Payer: Entrust Commercial |
$589.00
|
| Rate for Payer: First Choice Health Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$409.20
|
| Rate for Payer: HealthUtah PPO |
$620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
| Rate for Payer: Multiplan Medicare/VA |
$388.74
|
| Rate for Payer: One Health Plan of WY PPO |
$607.60
|
| Rate for Payer: PacificSource Commercial |
$558.00
|
| Rate for Payer: PHCS PPO |
$607.60
|
| Rate for Payer: Three Rivers PPO |
$465.00
|
| Rate for Payer: TriWest Veterans Administration |
$409.20
|
| Rate for Payer: United Healthcare Commercial |
$539.40
|
| Rate for Payer: United Healthcare Medicare |
$409.20
|
| Rate for Payer: WINHealth Partners Commercial |
$589.00
|
| Rate for Payer: Wise Provider Network Commercial |
$589.00
|
|
|
HC HANDLING SPECIMEN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 99001
|
| Hospital Charge Code |
3009900101
|
|
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 HANDLING SPECIMEN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 99001
|
| Hospital Charge Code |
3009900101
|
|
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 HANGE OF GASTROS-MY TUBE
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
3204376001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.64 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$371.20
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC HANGE OF GASTROS-MY TUBE
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
3204376001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC HAST W/REPORT - HIGH ALTITUDE SIMULATION TEST
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 94452
|
| Hospital Charge Code |
4609445201
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.40
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$150.48
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$158.40
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC HAST W/REPORT - HIGH ALTITUDE SIMULATION TEST
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 94452
|
| Hospital Charge Code |
4609445201
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$158.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.20
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$132.24
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: WINHealth Partners Commercial |
$235.20
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC HAST W/REPORT - HIGH ALTITUDE SIMULATION TEST W/02
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 94453
|
| Hospital Charge Code |
4609445301
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC HAST W/REPORT - HIGH ALTITUDE SIMULATION TEST W/02
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 94453
|
| Hospital Charge Code |
4609445301
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 81269
|
| Hospital Charge Code |
3108126901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$389.56 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Aetna of WY Medicare |
$466.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.72
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.06
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$389.56
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$410.06
|
| Rate for Payer: United Healthcare Commercial |
$615.09
|
| Rate for Payer: United Healthcare Medicare |
$410.06
|
| Rate for Payer: WINHealth Partners Commercial |
$692.86
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
HC HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 81269
|
| Hospital Charge Code |
3108126901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$443.29 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.72
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.62
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$443.29
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$466.62
|
| Rate for Payer: United Healthcare Commercial |
$615.09
|
| Rate for Payer: United Healthcare Medicare |
$466.62
|
| Rate for Payer: WINHealth Partners Commercial |
$671.65
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
HC HBA1/HBA2 GENE - GENE TEST BETA-THALASSEMIA
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
3008125701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$379.96 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$581.76
|
| Rate for Payer: Altius Commercial |
$581.76
|
| Rate for Payer: Beech Street Commercial |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$497.53
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.82
|
| Rate for Payer: Cigna of WY Commercial |
$593.88
|
| Rate for Payer: Entrust Commercial |
$575.70
|
| Rate for Payer: First Choice Health Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.96
|
| Rate for Payer: HealthUtah PPO |
$606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.82
|
| Rate for Payer: Multiplan Medicare/VA |
$379.96
|
| Rate for Payer: One Health Plan of WY PPO |
$593.88
|
| Rate for Payer: PacificSource Commercial |
$545.40
|
| Rate for Payer: PHCS PPO |
$593.88
|
| Rate for Payer: Three Rivers PPO |
$454.50
|
| Rate for Payer: TriWest Veterans Administration |
$399.96
|
| Rate for Payer: United Healthcare Commercial |
$527.22
|
| Rate for Payer: United Healthcare Medicare |
$399.96
|
| Rate for Payer: WINHealth Partners Commercial |
$575.70
|
| Rate for Payer: Wise Provider Network Commercial |
$575.70
|
|
|
HC HBA1/HBA2 GENE - GENE TEST BETA-THALASSEMIA
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
3008125701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.88
|
| Rate for Payer: Aetna of WY Medicare |
$399.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$581.76
|
| Rate for Payer: Altius Commercial |
$581.76
|
| Rate for Payer: Beech Street Commercial |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$497.53
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.82
|
| Rate for Payer: Cigna of WY Commercial |
$593.88
|
| Rate for Payer: Entrust Commercial |
$575.70
|
| Rate for Payer: First Choice Health Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.48
|
| Rate for Payer: HealthUtah PPO |
$606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.82
|
| Rate for Payer: Multiplan Medicare/VA |
$333.91
|
| Rate for Payer: One Health Plan of WY PPO |
$593.88
|
| Rate for Payer: PacificSource Commercial |
$545.40
|
| Rate for Payer: PHCS PPO |
$593.88
|
| Rate for Payer: Three Rivers PPO |
$454.50
|
| Rate for Payer: TriWest Veterans Administration |
$351.48
|
| Rate for Payer: United Healthcare Commercial |
$527.22
|
| Rate for Payer: United Healthcare Medicare |
$351.48
|
| Rate for Payer: WINHealth Partners Commercial |
$593.88
|
| Rate for Payer: Wise Provider Network Commercial |
$575.70
|
|
|
HC HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN ASPERGILLUS FUMIGATUS IGG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
3028600143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN ASPERGILLUS FUMIGATUS IGG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
3028600143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC HC AMINO ACID, SINGLE QUAL - S SULFOCYSTEINE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 82127
|
| Hospital Charge Code |
3018212701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HC AMINO ACID, SINGLE QUAL - S SULFOCYSTEINE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 82127
|
| Hospital Charge Code |
3018212701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HC DRUG TEST PRSMV CHEM ANLYZR - CARISOPRODOL SCREEN URINE
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$943.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$787.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$829.40
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$829.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC HC DRUG TEST PRSMV CHEM ANLYZR - CARISOPRODOL SCREEN URINE
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$896.61 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.80
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$896.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$943.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,358.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC HC NEPHELOMETRY, NOT SPECIFIED - KAPPA/LAMBDA BLOOD TOTAL RATIO
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC HC NEPHELOMETRY, NOT SPECIFIED - KAPPA/LAMBDA BLOOD TOTAL RATIO
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC HC PROTEIN, WESTERN BLOT TEST, W BAND ID - NEURONAL NUCLEAR AB TITTE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3018625601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$12.05
|
| Rate for Payer: Beech Street Commercial |
$175.75
|
| Rate for Payer: Cash Price |
$129.50
|
| 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: First Choice Health Commercial |
$166.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.05
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$10.24
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$175.75
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$12.05
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
|
|
HC HC PROTEIN, WESTERN BLOT TEST, W BAND ID OTH FLUID
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
3018418201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$29.21
|
| Rate for Payer: Beech Street Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: First Choice Health Commercial |
$90.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.21
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$24.83
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$95.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$29.21
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$29.21
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
|
|
HC HEAL & BEHAV ASSESSMENT INDIVIDUAL 30 MIN
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 96158
|
| Hospital Charge Code |
9009615801
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC HEAL & BEHAV ASSESSMENT INDIVIDUAL 30 MIN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 96158
|
| Hospital Charge Code |
9009615801
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: Optum Behavioral Health Commercial |
$59.71
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
