|
HC INSERT EMERGENCY ENDOTRACH AIRWAY
|
Facility
|
IP
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
7613150001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,106.03 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,728.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,693.44
|
| Rate for Payer: Altius Commercial |
$1,693.44
|
| Rate for Payer: Beech Street Commercial |
$1,728.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,448.24
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,711.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,728.72
|
| Rate for Payer: Entrust Commercial |
$1,675.80
|
| Rate for Payer: First Choice Health Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,164.24
|
| Rate for Payer: HealthUtah PPO |
$1,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,711.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1,106.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,728.72
|
| Rate for Payer: PacificSource Commercial |
$1,587.60
|
| Rate for Payer: PHCS PPO |
$1,728.72
|
| Rate for Payer: Three Rivers PPO |
$1,323.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,164.24
|
| Rate for Payer: United Healthcare Commercial |
$1,534.68
|
| Rate for Payer: United Healthcare Medicare |
$1,164.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,675.80
|
|
|
HC INSERT EMERGENCY ENDOTRACH AIRWAY
|
Facility
|
OP
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
7613150001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$971.96 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,728.72
|
| Rate for Payer: Aetna of WY Medicare |
$1,164.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,693.44
|
| Rate for Payer: Altius Commercial |
$1,693.44
|
| Rate for Payer: Beech Street Commercial |
$1,728.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,448.24
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,711.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,728.72
|
| Rate for Payer: Entrust Commercial |
$1,675.80
|
| Rate for Payer: First Choice Health Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,023.12
|
| Rate for Payer: HealthUtah PPO |
$1,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,711.08
|
| Rate for Payer: Multiplan Medicare/VA |
$971.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,728.72
|
| Rate for Payer: PacificSource Commercial |
$1,587.60
|
| Rate for Payer: PHCS PPO |
$1,728.72
|
| Rate for Payer: Three Rivers PPO |
$1,323.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,023.12
|
| Rate for Payer: United Healthcare Commercial |
$1,534.68
|
| Rate for Payer: United Healthcare Medicare |
$1,023.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,728.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1,675.80
|
|
|
HC INSERT EMERGENCY ENDOTRACH AIRWAY
|
Facility
|
IP
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4603150001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$1,106.03 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,728.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,523.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,693.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,492.80
|
| Rate for Payer: Altius Commercial |
$1,492.80
|
| Rate for Payer: Altius Commercial |
$1,693.44
|
| Rate for Payer: Beech Street Commercial |
$1,728.72
|
| Rate for Payer: Beech Street Commercial |
$1,523.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,276.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,448.24
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,088.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,508.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,711.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,728.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,523.90
|
| Rate for Payer: Entrust Commercial |
$1,477.25
|
| Rate for Payer: Entrust Commercial |
$1,675.80
|
| Rate for Payer: First Choice Health Commercial |
$1,477.25
|
| Rate for Payer: First Choice Health Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,477.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,164.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,026.30
|
| Rate for Payer: HealthUtah PPO |
$1,764.00
|
| Rate for Payer: HealthUtah PPO |
$1,555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,508.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,711.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1,106.03
|
| Rate for Payer: Multiplan Medicare/VA |
$974.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,728.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,523.90
|
| Rate for Payer: PacificSource Commercial |
$1,587.60
|
| Rate for Payer: PacificSource Commercial |
$1,399.50
|
| Rate for Payer: PHCS PPO |
$1,523.90
|
| Rate for Payer: PHCS PPO |
$1,728.72
|
| Rate for Payer: Three Rivers PPO |
$1,166.25
|
| Rate for Payer: Three Rivers PPO |
$1,323.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,164.24
|
| Rate for Payer: TriWest Veterans Administration |
$1,026.30
|
| Rate for Payer: United Healthcare Commercial |
$1,352.85
|
| Rate for Payer: United Healthcare Commercial |
$1,534.68
|
| Rate for Payer: United Healthcare Medicare |
$1,164.24
|
| Rate for Payer: United Healthcare Medicare |
$1,026.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,477.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,477.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,675.80
|
|
|
HC INSERT EMERGENCY ENDOTRACH AIRWAY
|
Facility
|
OP
|
$1,764.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
4603150001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$971.96 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,728.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,523.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,164.24
|
| Rate for Payer: Aetna of WY Medicare |
$1,026.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,492.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,693.44
|
| Rate for Payer: Altius Commercial |
$1,693.44
|
| Rate for Payer: Altius Commercial |
$1,492.80
|
| Rate for Payer: Beech Street Commercial |
$1,523.90
|
| Rate for Payer: Beech Street Commercial |
$1,728.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,448.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,276.66
|
| Rate for Payer: Cash Price |
$1,088.50
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,711.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,508.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,523.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,728.72
|
| Rate for Payer: Entrust Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,477.25
|
| Rate for Payer: First Choice Health Commercial |
$1,477.25
|
| Rate for Payer: First Choice Health Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,477.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,675.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,023.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$901.90
|
| Rate for Payer: HealthUtah PPO |
$1,555.00
|
| Rate for Payer: HealthUtah PPO |
$1,764.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,508.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,711.08
|
| Rate for Payer: Multiplan Medicare/VA |
$971.96
|
| Rate for Payer: Multiplan Medicare/VA |
$856.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,523.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,728.72
|
| Rate for Payer: PacificSource Commercial |
$1,587.60
|
| Rate for Payer: PacificSource Commercial |
$1,399.50
|
| Rate for Payer: PHCS PPO |
$1,523.90
|
| Rate for Payer: PHCS PPO |
$1,728.72
|
| Rate for Payer: Three Rivers PPO |
$1,166.25
|
| Rate for Payer: Three Rivers PPO |
$1,323.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,023.12
|
| Rate for Payer: TriWest Veterans Administration |
$901.90
|
| Rate for Payer: United Healthcare Commercial |
$1,352.85
|
| Rate for Payer: United Healthcare Commercial |
$1,534.68
|
| Rate for Payer: United Healthcare Medicare |
$1,023.12
|
| Rate for Payer: United Healthcare Medicare |
$901.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,523.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,728.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1,477.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,675.80
|
|
|
HC INSERT INTRAUTERINE DEVICE
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
5105830001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC INSERT INTRAUTERINE DEVICE
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
5105830001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$57.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.46
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.94
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
| Rate for Payer: WINHealth Partners Commercial |
$85.26
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
5105920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
5105920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 20650
|
| Hospital Charge Code |
5102065001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.26 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$106.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.96
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$89.26
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.96
|
| Rate for Payer: United Healthcare Commercial |
$140.94
|
| Rate for Payer: United Healthcare Medicare |
$93.96
|
| Rate for Payer: WINHealth Partners Commercial |
$158.76
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 20650
|
| Hospital Charge Code |
5102065001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.92
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$101.57
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.92
|
| Rate for Payer: United Healthcare Commercial |
$140.94
|
| Rate for Payer: United Healthcare Medicare |
$106.92
|
| Rate for Payer: WINHealth Partners Commercial |
$153.90
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC INSERT NEEDLE,INTRAOSSEOUS INFUSN
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
7613668001
|
|
Hospital Revenue Code
|
761
|
| 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 INSERT NEEDLE,INTRAOSSEOUS INFUSN
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
7613668001
|
|
Hospital Revenue Code
|
761
|
| 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 INSERT NEEDLE,INTRAOSSEOUS INFUSN
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5103668001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.92
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$38.87
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.92
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$40.92
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC INSERT NEEDLE,INTRAOSSEOUS INFUSN
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
5103668001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$40.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.96
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$34.16
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.96
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$35.96
|
| Rate for Payer: WINHealth Partners Commercial |
$60.76
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC INSERT,NON-INDWELLING BLADDER CATHETER
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
5105170101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERT,NON-INDWELLING BLADDER CATHETER
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
5105170101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
7613655601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
7613655601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INSERT NON-TUNNEL CV CATH >5 Y/O
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
3203655601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,884.42 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,351.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,257.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,283.20
|
| Rate for Payer: Altius Commercial |
$3,283.20
|
| Rate for Payer: Beech Street Commercial |
$3,351.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,807.82
|
| Rate for Payer: Cash Price |
$2,394.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,317.40
|
| Rate for Payer: Cigna of WY Commercial |
$3,351.60
|
| Rate for Payer: Entrust Commercial |
$3,249.00
|
| Rate for Payer: First Choice Health Commercial |
$3,249.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,249.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,983.60
|
| Rate for Payer: HealthUtah PPO |
$3,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,317.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,884.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,351.60
|
| Rate for Payer: PacificSource Commercial |
$3,078.00
|
| Rate for Payer: PHCS PPO |
$3,351.60
|
| Rate for Payer: Three Rivers PPO |
$2,565.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,983.60
|
| Rate for Payer: United Healthcare Commercial |
$2,975.40
|
| Rate for Payer: United Healthcare Medicare |
$1,983.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,351.60
|
| Rate for Payer: Wise Provider Network Commercial |
$3,249.00
|
|
|
HC INSERT NON-TUNNEL CV CATH >5 Y/O
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
3203655601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,144.34 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,351.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,283.20
|
| Rate for Payer: Altius Commercial |
$3,283.20
|
| Rate for Payer: Beech Street Commercial |
$3,351.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,807.82
|
| Rate for Payer: Cash Price |
$2,394.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,317.40
|
| Rate for Payer: Cigna of WY Commercial |
$3,351.60
|
| Rate for Payer: Entrust Commercial |
$3,249.00
|
| Rate for Payer: First Choice Health Commercial |
$3,249.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,249.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,257.20
|
| Rate for Payer: HealthUtah PPO |
$3,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,317.40
|
| Rate for Payer: Multiplan Medicare/VA |
$2,144.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,351.60
|
| Rate for Payer: PacificSource Commercial |
$3,078.00
|
| Rate for Payer: PHCS PPO |
$3,351.60
|
| Rate for Payer: Three Rivers PPO |
$2,565.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,257.20
|
| Rate for Payer: United Healthcare Commercial |
$2,975.40
|
| Rate for Payer: United Healthcare Medicare |
$2,257.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,249.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,249.00
|
|
|
HC INSERT PICC W/O SUB-Q PORT
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
7613656901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INSERT PICC W/O SUB-Q PORT
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
7613656901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/IMAGE GUIDE >5 Y/O
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
7603657301
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$2,837.65 |
| Max. Negotiated Rate |
$5,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,047.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,399.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,944.00
|
| Rate for Payer: Altius Commercial |
$4,944.00
|
| Rate for Payer: Beech Street Commercial |
$5,047.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,228.15
|
| Rate for Payer: Cash Price |
$3,605.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,995.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,047.00
|
| Rate for Payer: Entrust Commercial |
$4,892.50
|
| Rate for Payer: First Choice Health Commercial |
$4,892.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,892.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,987.00
|
| Rate for Payer: HealthUtah PPO |
$5,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,995.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,837.65
|
| Rate for Payer: One Health Plan of WY PPO |
$5,047.00
|
| Rate for Payer: PacificSource Commercial |
$4,635.00
|
| Rate for Payer: PHCS PPO |
$5,047.00
|
| Rate for Payer: Three Rivers PPO |
$3,862.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,987.00
|
| Rate for Payer: United Healthcare Commercial |
$4,480.50
|
| Rate for Payer: United Healthcare Medicare |
$2,987.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,047.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,892.50
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/IMAGE GUIDE >5 Y/O
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
7603657301
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,229.05 |
| Max. Negotiated Rate |
$5,150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,047.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,944.00
|
| Rate for Payer: Altius Commercial |
$4,944.00
|
| Rate for Payer: Beech Street Commercial |
$5,047.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,228.15
|
| Rate for Payer: Cash Price |
$3,605.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,995.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,047.00
|
| Rate for Payer: Entrust Commercial |
$4,892.50
|
| Rate for Payer: First Choice Health Commercial |
$4,892.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,892.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,399.00
|
| Rate for Payer: HealthUtah PPO |
$5,150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,995.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,229.05
|
| Rate for Payer: One Health Plan of WY PPO |
$5,047.00
|
| Rate for Payer: PacificSource Commercial |
$4,635.00
|
| Rate for Payer: PHCS PPO |
$5,047.00
|
| Rate for Payer: Three Rivers PPO |
$3,862.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,399.00
|
| Rate for Payer: United Healthcare Commercial |
$4,480.50
|
| Rate for Payer: United Healthcare Medicare |
$3,399.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,892.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,892.50
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/IMAGE GUIDE >5 Y/O
|
Facility
|
IP
|
$7,330.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
7613657301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,595.91 |
| Max. Negotiated Rate |
$7,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,183.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,036.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Altius Commercial |
$7,036.80
|
| Rate for Payer: Beech Street Commercial |
$7,183.40
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,017.93
|
| Rate for Payer: Cash Price |
$5,131.00
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,110.10
|
| Rate for Payer: Cigna of WY Commercial |
$7,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: Entrust Commercial |
$6,963.50
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$6,963.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,963.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,837.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$7,330.00
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,110.10
|
| Rate for Payer: Multiplan Medicare/VA |
$4,595.91
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$7,183.40
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$6,597.00
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$7,183.40
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$5,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,837.80
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$6,377.10
|
| Rate for Payer: United Healthcare Medicare |
$4,837.80
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,963.50
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$6,963.50
|
|
