|
HC LAB VET FIBRINOGEN
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
3000000011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC LAB VET FIBRINOGEN
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
3000000011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.78
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.69
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.78
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$21.78
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE BLOOD
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE BLOOD
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE PLEURAL FLUID
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE PLEURAL FLUID
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC LAPAROSCOPY PROCEDURE
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
3600000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,022.01 |
| Max. Negotiated Rate |
$1,630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,597.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,564.80
|
| Rate for Payer: Altius Commercial |
$1,564.80
|
| Rate for Payer: Beech Street Commercial |
$1,597.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,338.23
|
| Rate for Payer: Cash Price |
$1,141.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,581.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,597.40
|
| Rate for Payer: Entrust Commercial |
$1,548.50
|
| Rate for Payer: First Choice Health Commercial |
$1,548.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,548.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,075.80
|
| Rate for Payer: HealthUtah PPO |
$1,630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,581.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,022.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,597.40
|
| Rate for Payer: PacificSource Commercial |
$1,467.00
|
| Rate for Payer: PHCS PPO |
$1,597.40
|
| Rate for Payer: Three Rivers PPO |
$1,222.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,075.80
|
| Rate for Payer: United Healthcare Commercial |
$1,418.10
|
| Rate for Payer: United Healthcare Medicare |
$1,075.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,548.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,548.50
|
|
|
HC LAPAROSCOPY PROCEDURE
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
3600000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$898.13 |
| Max. Negotiated Rate |
$1,630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,597.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,075.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,564.80
|
| Rate for Payer: Altius Commercial |
$1,564.80
|
| Rate for Payer: Beech Street Commercial |
$1,597.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,338.23
|
| Rate for Payer: Cash Price |
$1,141.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,581.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,597.40
|
| Rate for Payer: Entrust Commercial |
$1,548.50
|
| Rate for Payer: First Choice Health Commercial |
$1,548.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,548.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$945.40
|
| Rate for Payer: HealthUtah PPO |
$1,630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,581.10
|
| Rate for Payer: Multiplan Medicare/VA |
$898.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,597.40
|
| Rate for Payer: PacificSource Commercial |
$1,467.00
|
| Rate for Payer: PHCS PPO |
$1,597.40
|
| Rate for Payer: Three Rivers PPO |
$1,222.50
|
| Rate for Payer: TriWest Veterans Administration |
$945.40
|
| Rate for Payer: United Healthcare Commercial |
$1,418.10
|
| Rate for Payer: United Healthcare Medicare |
$945.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,597.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,548.50
|
|
|
HC LAP CHOLEYSTECTOMY PROCEDURE
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
3600000013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$912.28 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$960.30
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$912.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$960.30
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$960.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,382.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC LAP CHOLEYSTECTOMY PROCEDURE
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
3600000013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$801.70 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Aetna of WY Medicare |
$960.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.90
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$801.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.90
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$843.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC LAP HYSTERECTOMY PROCEDURE
|
Facility
|
IP
|
$5,530.00
|
|
| Hospital Charge Code |
3600000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,467.31 |
| Max. Negotiated Rate |
$5,530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,419.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,308.80
|
| Rate for Payer: Altius Commercial |
$5,308.80
|
| Rate for Payer: Beech Street Commercial |
$5,419.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,540.13
|
| Rate for Payer: Cash Price |
$3,871.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,364.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,419.40
|
| Rate for Payer: Entrust Commercial |
$5,253.50
|
| Rate for Payer: First Choice Health Commercial |
$5,253.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,253.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,649.80
|
| Rate for Payer: HealthUtah PPO |
$5,530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,364.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3,467.31
|
| Rate for Payer: One Health Plan of WY PPO |
$5,419.40
|
| Rate for Payer: PacificSource Commercial |
$4,977.00
|
| Rate for Payer: PHCS PPO |
$5,419.40
|
| Rate for Payer: Three Rivers PPO |
$4,147.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,649.80
|
| Rate for Payer: United Healthcare Commercial |
$4,811.10
|
| Rate for Payer: United Healthcare Medicare |
$3,649.80
|
| Rate for Payer: WINHealth Partners Commercial |
$5,253.50
|
| Rate for Payer: Wise Provider Network Commercial |
$5,253.50
|
|
|
HC LAP HYSTERECTOMY PROCEDURE
|
Facility
|
OP
|
$5,530.00
|
|
| Hospital Charge Code |
3600000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,047.03 |
| Max. Negotiated Rate |
$5,530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,419.40
|
| Rate for Payer: Aetna of WY Medicare |
$3,649.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,308.80
|
| Rate for Payer: Altius Commercial |
$5,308.80
|
| Rate for Payer: Beech Street Commercial |
$5,419.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,540.13
|
| Rate for Payer: Cash Price |
$3,871.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,364.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,419.40
|
| Rate for Payer: Entrust Commercial |
$5,253.50
|
| Rate for Payer: First Choice Health Commercial |
$5,253.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,253.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,207.40
|
| Rate for Payer: HealthUtah PPO |
$5,530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,364.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3,047.03
|
| Rate for Payer: One Health Plan of WY PPO |
$5,419.40
|
| Rate for Payer: PacificSource Commercial |
$4,977.00
|
| Rate for Payer: PHCS PPO |
$5,419.40
|
| Rate for Payer: Three Rivers PPO |
$4,147.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,207.40
|
| Rate for Payer: United Healthcare Commercial |
$4,811.10
|
| Rate for Payer: United Healthcare Medicare |
$3,207.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,419.40
|
| Rate for Payer: Wise Provider Network Commercial |
$5,253.50
|
|
|
HC LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Facility
|
IP
|
$3,649.00
|
|
|
Service Code
|
HCPCS 58571
|
| Hospital Charge Code |
9835857101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,287.92 |
| Max. Negotiated Rate |
$3,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,576.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,503.04
|
| Rate for Payer: Altius Commercial |
$3,503.04
|
| Rate for Payer: Beech Street Commercial |
$3,576.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,995.83
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,539.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,576.02
|
| Rate for Payer: Entrust Commercial |
$3,466.55
|
| Rate for Payer: First Choice Health Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,408.34
|
| Rate for Payer: HealthUtah PPO |
$3,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,539.53
|
| Rate for Payer: Multiplan Medicare/VA |
$2,287.92
|
| Rate for Payer: One Health Plan of WY PPO |
$3,576.02
|
| Rate for Payer: PacificSource Commercial |
$3,284.10
|
| Rate for Payer: PHCS PPO |
$3,576.02
|
| Rate for Payer: Three Rivers PPO |
$2,736.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,408.34
|
| Rate for Payer: United Healthcare Commercial |
$3,174.63
|
| Rate for Payer: United Healthcare Medicare |
$2,408.34
|
| Rate for Payer: WINHealth Partners Commercial |
$3,466.55
|
| Rate for Payer: Wise Provider Network Commercial |
$3,466.55
|
|
|
HC LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY
|
Facility
|
OP
|
$3,649.00
|
|
|
Service Code
|
HCPCS 58571
|
| Hospital Charge Code |
9835857101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$2,010.60 |
| Max. Negotiated Rate |
$3,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,576.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,408.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,503.04
|
| Rate for Payer: Altius Commercial |
$3,503.04
|
| Rate for Payer: Beech Street Commercial |
$3,576.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,995.83
|
| Rate for Payer: Cash Price |
$2,554.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,539.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,576.02
|
| Rate for Payer: Entrust Commercial |
$3,466.55
|
| Rate for Payer: First Choice Health Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,466.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,116.42
|
| Rate for Payer: HealthUtah PPO |
$3,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,539.53
|
| Rate for Payer: Multiplan Medicare/VA |
$2,010.60
|
| Rate for Payer: One Health Plan of WY PPO |
$3,576.02
|
| Rate for Payer: PacificSource Commercial |
$3,284.10
|
| Rate for Payer: PHCS PPO |
$3,576.02
|
| Rate for Payer: Three Rivers PPO |
$2,736.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,116.42
|
| Rate for Payer: United Healthcare Commercial |
$3,174.63
|
| Rate for Payer: United Healthcare Medicare |
$2,116.42
|
| Rate for Payer: WINHealth Partners Commercial |
$3,576.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3,466.55
|
|
|
HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
5103157501
|
|
Hospital Revenue Code
|
510
|
| 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 LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
5103157501
|
|
Hospital Revenue Code
|
510
|
| 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 LAYR CLOS WND FACE,FACIAL 12.6-20 CM
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
7611205501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Aetna of WY Medicare |
$262.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$381.12
|
| Rate for Payer: Altius Commercial |
$381.12
|
| Rate for Payer: Beech Street Commercial |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$325.94
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: Entrust Commercial |
$377.15
|
| Rate for Payer: First Choice Health Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$230.26
|
| Rate for Payer: HealthUtah PPO |
$397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Multiplan Medicare/VA |
$218.75
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PHCS PPO |
$389.06
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: TriWest Veterans Administration |
$230.26
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: United Healthcare Medicare |
$230.26
|
| Rate for Payer: WINHealth Partners Commercial |
$389.06
|
| Rate for Payer: Wise Provider Network Commercial |
$377.15
|
|
|
HC LAYR CLOS WND FACE,FACIAL 12.6-20 CM
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
7611205501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$381.12
|
| Rate for Payer: Altius Commercial |
$381.12
|
| Rate for Payer: Beech Street Commercial |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$325.94
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: Entrust Commercial |
$377.15
|
| Rate for Payer: First Choice Health Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.02
|
| Rate for Payer: HealthUtah PPO |
$397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Multiplan Medicare/VA |
$248.92
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PHCS PPO |
$389.06
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.02
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: United Healthcare Medicare |
$262.02
|
| Rate for Payer: WINHealth Partners Commercial |
$377.15
|
| Rate for Payer: Wise Provider Network Commercial |
$377.15
|
|
|
HC LAYR CLOS WND FACE,FACIAL 2.5-5
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
5101205201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Aetna of WY Medicare |
$132.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.96
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.02
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.58
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$110.75
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$116.58
|
| Rate for Payer: United Healthcare Commercial |
$174.87
|
| Rate for Payer: United Healthcare Medicare |
$116.58
|
| Rate for Payer: WINHealth Partners Commercial |
$196.98
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC LAYR CLOS WND FACE,FACIAL 2.5-5
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
5101205201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.96
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.02
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.66
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$126.03
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.66
|
| Rate for Payer: United Healthcare Commercial |
$174.87
|
| Rate for Payer: United Healthcare Medicare |
$132.66
|
| Rate for Payer: WINHealth Partners Commercial |
$190.95
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
7611205201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.48 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$284.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.98
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$237.48
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$249.98
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$249.98
|
| Rate for Payer: WINHealth Partners Commercial |
$422.38
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
7611205201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.46
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$270.24
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$284.46
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$284.46
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
7611205101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.59 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.36
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$185.59
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$195.36
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$195.36
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
