|
HC CONTROL THROAT BLEED,SIMPLE
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
7614296001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI W/ DBL CONT W/ SMALL BOWEL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
3207424901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$611.90 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Aetna of WY Medicare |
$745.80
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,096.10
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$644.10
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$611.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$644.10
|
| Rate for Payer: United Healthcare Commercial |
$1,079.15
|
| Rate for Payer: United Healthcare Medicare |
$644.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI W/ DBL CONT W/ SMALL BOWEL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
3207424901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$654.84 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Aetna of WY Medicare |
$723.20
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,096.10
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.30
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$654.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$689.30
|
| Rate for Payer: United Healthcare Commercial |
$1,079.15
|
| Rate for Payer: United Healthcare Medicare |
$689.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,073.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC CORTISOL, FREE - CORTISOL 24HR URINARY FREE
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.06 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Aetna of WY Medicare |
$96.36
|
| Rate for Payer: Altius Commercial |
$140.16
|
| Rate for Payer: Beech Street Commercial |
$143.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.62
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: Entrust Commercial |
$138.70
|
| Rate for Payer: First Choice Health Commercial |
$138.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.22
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: Multiplan Medicare/VA |
$79.06
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$143.08
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: TriWest Veterans Administration |
$83.22
|
| Rate for Payer: United Healthcare Commercial |
$139.43
|
| Rate for Payer: United Healthcare Medicare |
$83.22
|
| Rate for Payer: WINHealth Partners Commercial |
$143.08
|
| Rate for Payer: Wise Provider Network Commercial |
$138.70
|
|
|
HC CORTISOL, FREE - CORTISOL 24HR URINARY FREE
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Aetna of WY Medicare |
$93.44
|
| Rate for Payer: Altius Commercial |
$140.16
|
| Rate for Payer: Beech Street Commercial |
$143.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.62
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: Entrust Commercial |
$138.70
|
| Rate for Payer: First Choice Health Commercial |
$138.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.06
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: Multiplan Medicare/VA |
$84.61
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$143.08
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: TriWest Veterans Administration |
$89.06
|
| Rate for Payer: United Healthcare Commercial |
$139.43
|
| Rate for Payer: United Healthcare Medicare |
$89.06
|
| Rate for Payer: WINHealth Partners Commercial |
$138.70
|
| Rate for Payer: Wise Provider Network Commercial |
$138.70
|
|
|
HC CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.77 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Aetna of WY Medicare |
$83.82
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.19
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.39
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$68.77
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$72.39
|
| Rate for Payer: United Healthcare Commercial |
$121.28
|
| Rate for Payer: United Healthcare Medicare |
$72.39
|
| Rate for Payer: WINHealth Partners Commercial |
$124.46
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Aetna of WY Medicare |
$81.28
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.19
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.47
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$73.60
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$77.47
|
| Rate for Payer: United Healthcare Commercial |
$121.28
|
| Rate for Payer: United Healthcare Medicare |
$77.47
|
| Rate for Payer: WINHealth Partners Commercial |
$120.65
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.85 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$100.98
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.41
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.21
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$82.85
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.21
|
| Rate for Payer: United Healthcare Commercial |
$146.12
|
| Rate for Payer: United Healthcare Medicare |
$87.21
|
| Rate for Payer: WINHealth Partners Commercial |
$149.94
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$97.92
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.41
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.33
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$88.66
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.33
|
| Rate for Payer: United Healthcare Commercial |
$146.12
|
| Rate for Payer: United Healthcare Medicare |
$93.33
|
| Rate for Payer: WINHealth Partners Commercial |
$145.35
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC CREATINE, MB FRACTION - CKMB
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.07 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$141.44
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.81
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$128.07
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$134.81
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$134.81
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC CREATINE, MB FRACTION - CKMB
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.67 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$145.86
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.97
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$119.67
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.97
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$125.97
|
| Rate for Payer: WINHealth Partners Commercial |
$216.58
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.77 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Medicare |
$219.52
|
| Rate for Payer: Altius Commercial |
$329.28
|
| Rate for Payer: Beech Street Commercial |
$336.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.71
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: Entrust Commercial |
$325.85
|
| Rate for Payer: First Choice Health Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.23
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Multiplan Medicare/VA |
$198.77
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$336.14
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: TriWest Veterans Administration |
$209.23
|
| Rate for Payer: United Healthcare Commercial |
$327.56
|
| Rate for Payer: United Healthcare Medicare |
$209.23
|
| Rate for Payer: WINHealth Partners Commercial |
$325.85
|
| Rate for Payer: Wise Provider Network Commercial |
$325.85
|
|
|
HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$185.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Medicare |
$226.38
|
| Rate for Payer: Altius Commercial |
$329.28
|
| Rate for Payer: Beech Street Commercial |
$336.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.71
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: Entrust Commercial |
$325.85
|
| Rate for Payer: First Choice Health Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.51
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Multiplan Medicare/VA |
$185.73
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$336.14
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: TriWest Veterans Administration |
$195.51
|
| Rate for Payer: United Healthcare Commercial |
$327.56
|
| Rate for Payer: United Healthcare Medicare |
$195.51
|
| Rate for Payer: WINHealth Partners Commercial |
$336.14
|
| Rate for Payer: Wise Provider Network Commercial |
$325.85
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$298.91 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$364.32
|
| Rate for Payer: Altius Commercial |
$529.92
|
| Rate for Payer: Beech Street Commercial |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$535.44
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: Entrust Commercial |
$524.40
|
| Rate for Payer: First Choice Health Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.64
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$298.91
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$540.96
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$314.64
|
| Rate for Payer: United Healthcare Commercial |
$527.16
|
| Rate for Payer: United Healthcare Medicare |
$314.64
|
| Rate for Payer: WINHealth Partners Commercial |
$540.96
|
| Rate for Payer: Wise Provider Network Commercial |
$524.40
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$319.88 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$353.28
|
| Rate for Payer: Altius Commercial |
$529.92
|
| Rate for Payer: Beech Street Commercial |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$535.44
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: Entrust Commercial |
$524.40
|
| Rate for Payer: First Choice Health Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.72
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$319.88
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$540.96
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.72
|
| Rate for Payer: United Healthcare Commercial |
$527.16
|
| Rate for Payer: United Healthcare Medicare |
$336.72
|
| Rate for Payer: WINHealth Partners Commercial |
$524.40
|
| Rate for Payer: Wise Provider Network Commercial |
$524.40
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Facility
|
IP
|
$5,117.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,965.30 |
| Max. Negotiated Rate |
$5,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,014.66
|
| Rate for Payer: Aetna of WY Medicare |
$3,274.88
|
| Rate for Payer: Altius Commercial |
$4,912.32
|
| Rate for Payer: Beech Street Commercial |
$5,014.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,963.49
|
| Rate for Payer: Cash Price |
$3,581.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,963.49
|
| Rate for Payer: Cigna of WY Commercial |
$5,014.66
|
| Rate for Payer: Entrust Commercial |
$4,861.15
|
| Rate for Payer: First Choice Health Commercial |
$4,861.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,861.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,121.37
|
| Rate for Payer: HealthUtah PPO |
$5,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,963.49
|
| Rate for Payer: Multiplan Medicare/VA |
$2,965.30
|
| Rate for Payer: One Health Plan of WY PPO |
$5,014.66
|
| Rate for Payer: PacificSource Commercial |
$4,605.30
|
| Rate for Payer: PHCS PPO |
$5,014.66
|
| Rate for Payer: Three Rivers PPO |
$3,837.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,121.37
|
| Rate for Payer: United Healthcare Commercial |
$4,886.74
|
| Rate for Payer: United Healthcare Medicare |
$3,121.37
|
| Rate for Payer: WINHealth Partners Commercial |
$4,861.15
|
| Rate for Payer: Wise Provider Network Commercial |
$4,861.15
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Facility
|
OP
|
$5,117.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,770.86 |
| Max. Negotiated Rate |
$5,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,014.66
|
| Rate for Payer: Aetna of WY Medicare |
$3,377.22
|
| Rate for Payer: Altius Commercial |
$4,912.32
|
| Rate for Payer: Beech Street Commercial |
$5,014.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,963.49
|
| Rate for Payer: Cash Price |
$3,581.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,963.49
|
| Rate for Payer: Cigna of WY Commercial |
$5,014.66
|
| Rate for Payer: Entrust Commercial |
$4,861.15
|
| Rate for Payer: First Choice Health Commercial |
$4,861.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,861.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,916.69
|
| Rate for Payer: HealthUtah PPO |
$5,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,963.49
|
| Rate for Payer: Multiplan Medicare/VA |
$2,770.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,014.66
|
| Rate for Payer: PacificSource Commercial |
$4,605.30
|
| Rate for Payer: PHCS PPO |
$5,014.66
|
| Rate for Payer: Three Rivers PPO |
$3,837.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,916.69
|
| Rate for Payer: United Healthcare Commercial |
$4,886.74
|
| Rate for Payer: United Healthcare Medicare |
$2,916.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,014.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4,861.15
|
|
|
HC CROSSMATCH IMMEDIATE SPIN TECHNIQUE
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.06 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$263.34
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$387.03
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.43
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$216.06
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$227.43
|
| Rate for Payer: United Healthcare Commercial |
$381.04
|
| Rate for Payer: United Healthcare Medicare |
$227.43
|
| Rate for Payer: WINHealth Partners Commercial |
$391.02
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
HC CROSSMATCH IMMEDIATE SPIN TECHNIQUE
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$231.22 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$255.36
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$387.03
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.39
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$231.22
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$243.39
|
| Rate for Payer: United Healthcare Commercial |
$381.04
|
| Rate for Payer: United Healthcare Medicare |
$243.39
|
| Rate for Payer: WINHealth Partners Commercial |
$379.05
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
HC CRYOPRECIPITATE EACH UNIT
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$399.86 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$441.60
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.30
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$420.90
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$399.86
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$420.90
|
| Rate for Payer: United Healthcare Commercial |
$658.95
|
| Rate for Payer: United Healthcare Medicare |
$420.90
|
| Rate for Payer: WINHealth Partners Commercial |
$655.50
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC CRYOPRECIPITATE EACH UNIT
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$373.64 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$455.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.30
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$393.30
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$373.64
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$393.30
|
| Rate for Payer: United Healthcare Commercial |
$658.95
|
| Rate for Payer: United Healthcare Medicare |
$393.30
|
| Rate for Payer: WINHealth Partners Commercial |
$676.20
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC C-SECTION PROCEDURE
|
Facility
|
OP
|
$790.00
|
|
| Hospital Charge Code |
3600000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.78 |
| Max. Negotiated Rate |
$790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$774.20
|
| Rate for Payer: Aetna of WY Medicare |
$521.40
|
| Rate for Payer: Altius Commercial |
$758.40
|
| Rate for Payer: Beech Street Commercial |
$774.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$766.30
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$766.30
|
| Rate for Payer: Cigna of WY Commercial |
$774.20
|
| Rate for Payer: Entrust Commercial |
$750.50
|
| Rate for Payer: First Choice Health Commercial |
$750.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$750.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.30
|
| Rate for Payer: HealthUtah PPO |
$790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$766.30
|
| Rate for Payer: Multiplan Medicare/VA |
$427.78
|
| Rate for Payer: One Health Plan of WY PPO |
$774.20
|
| Rate for Payer: PacificSource Commercial |
$711.00
|
| Rate for Payer: PHCS PPO |
$774.20
|
| Rate for Payer: Three Rivers PPO |
$592.50
|
| Rate for Payer: TriWest Veterans Administration |
$450.30
|
| Rate for Payer: United Healthcare Commercial |
$754.45
|
| Rate for Payer: United Healthcare Medicare |
$450.30
|
| Rate for Payer: WINHealth Partners Commercial |
$774.20
|
| Rate for Payer: Wise Provider Network Commercial |
$750.50
|
|
|
HC C-SECTION PROCEDURE
|
Facility
|
IP
|
$790.00
|
|
| Hospital Charge Code |
3600000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.80 |
| Max. Negotiated Rate |
$790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$774.20
|
| Rate for Payer: Aetna of WY Medicare |
$505.60
|
| Rate for Payer: Altius Commercial |
$758.40
|
| Rate for Payer: Beech Street Commercial |
$774.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$766.30
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$766.30
|
| Rate for Payer: Cigna of WY Commercial |
$774.20
|
| Rate for Payer: Entrust Commercial |
$750.50
|
| Rate for Payer: First Choice Health Commercial |
$750.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$750.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.90
|
| Rate for Payer: HealthUtah PPO |
$790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$766.30
|
| Rate for Payer: Multiplan Medicare/VA |
$457.80
|
| Rate for Payer: One Health Plan of WY PPO |
$774.20
|
| Rate for Payer: PacificSource Commercial |
$711.00
|
| Rate for Payer: PHCS PPO |
$774.20
|
| Rate for Payer: Three Rivers PPO |
$592.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.90
|
| Rate for Payer: United Healthcare Commercial |
$754.45
|
| Rate for Payer: United Healthcare Medicare |
$481.90
|
| Rate for Payer: WINHealth Partners Commercial |
$750.50
|
| Rate for Payer: Wise Provider Network Commercial |
$750.50
|
|
