|
HC MICROSOMAL ANTIBODY - ANTI-MICROSOMAL AB
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC MICROSOMAL ANTIBODY - ANTI-MICROSOMAL AB
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC MICROSOMAL ANTIBODY - LIVER-KIDNEY MICROSOME IGG
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC MICROSOMAL ANTIBODY - LIVER-KIDNEY MICROSOME IGG
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
3028637602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC MINIDOKA HEALTH FAIR PROFILE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
3000000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC MINIDOKA HEALTH FAIR PROFILE
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
3000000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC MINOR PROCEDURE LEVEL
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
3600000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC MINOR PROCEDURE LEVEL
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
3600000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC MIRENA, 52 MG
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
636J729801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,338.64 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,092.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,049.60
|
| Rate for Payer: Altius Commercial |
$2,049.60
|
| Rate for Payer: Beech Street Commercial |
$2,092.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,752.84
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,070.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,092.30
|
| Rate for Payer: Entrust Commercial |
$2,028.25
|
| Rate for Payer: First Choice Health Commercial |
$2,028.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,028.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,409.10
|
| Rate for Payer: HealthUtah PPO |
$2,135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,070.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,338.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,092.30
|
| Rate for Payer: PacificSource Commercial |
$1,921.50
|
| Rate for Payer: PHCS PPO |
$2,092.30
|
| Rate for Payer: Three Rivers PPO |
$1,601.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,409.10
|
| Rate for Payer: United Healthcare Commercial |
$1,857.45
|
| Rate for Payer: United Healthcare Medicare |
$1,409.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,028.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,028.25
|
|
|
HC MIRENA, 52 MG
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
636J729801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,176.38 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,092.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,409.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,049.60
|
| Rate for Payer: Altius Commercial |
$2,049.60
|
| Rate for Payer: Beech Street Commercial |
$2,092.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,752.84
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,070.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,092.30
|
| Rate for Payer: Entrust Commercial |
$2,028.25
|
| Rate for Payer: First Choice Health Commercial |
$2,028.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,028.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,238.30
|
| Rate for Payer: HealthUtah PPO |
$2,135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,070.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,176.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,092.30
|
| Rate for Payer: PacificSource Commercial |
$1,921.50
|
| Rate for Payer: PHCS PPO |
$2,092.30
|
| Rate for Payer: Three Rivers PPO |
$1,601.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,238.30
|
| Rate for Payer: United Healthcare Commercial |
$1,857.45
|
| Rate for Payer: United Healthcare Medicare |
$1,238.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,092.30
|
| Rate for Payer: Wise Provider Network Commercial |
$2,028.25
|
|
|
HC MITOCHONDRIAL ANTIBODY EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
3028638101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC MITOCHONDRIAL ANTIBODY EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
3028638101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 81294
|
| Hospital Charge Code |
3108129401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,188.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$991.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 81294
|
| Hospital Charge Code |
3108129401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,128.60 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,188.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,128.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,188.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,710.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC MLH1 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 81292
|
| Hospital Charge Code |
3108129201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,306.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,880.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,760.00
|
| Rate for Payer: Altius Commercial |
$5,760.00
|
| Rate for Payer: Beech Street Commercial |
$5,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,926.00
|
| Rate for Payer: Cash Price |
$4,200.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,820.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,880.00
|
| Rate for Payer: Entrust Commercial |
$5,700.00
|
| Rate for Payer: First Choice Health Commercial |
$5,700.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,700.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,480.00
|
| Rate for Payer: HealthUtah PPO |
$6,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,820.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,306.00
|
| Rate for Payer: One Health Plan of WY PPO |
$5,880.00
|
| Rate for Payer: PacificSource Commercial |
$5,400.00
|
| Rate for Payer: PHCS PPO |
$5,880.00
|
| Rate for Payer: Three Rivers PPO |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,480.00
|
| Rate for Payer: United Healthcare Commercial |
$5,220.00
|
| Rate for Payer: United Healthcare Medicare |
$3,480.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,880.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,700.00
|
|
|
HC MLH1 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 81292
|
| Hospital Charge Code |
3108129201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,762.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,880.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,760.00
|
| Rate for Payer: Altius Commercial |
$5,760.00
|
| Rate for Payer: Beech Street Commercial |
$5,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,926.00
|
| Rate for Payer: Cash Price |
$4,200.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,820.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,880.00
|
| Rate for Payer: Entrust Commercial |
$5,700.00
|
| Rate for Payer: First Choice Health Commercial |
$5,700.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,700.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,960.00
|
| Rate for Payer: HealthUtah PPO |
$6,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,820.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,762.00
|
| Rate for Payer: One Health Plan of WY PPO |
$5,880.00
|
| Rate for Payer: PacificSource Commercial |
$5,400.00
|
| Rate for Payer: PHCS PPO |
$5,880.00
|
| Rate for Payer: Three Rivers PPO |
$4,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,960.00
|
| Rate for Payer: United Healthcare Commercial |
$5,220.00
|
| Rate for Payer: United Healthcare Medicare |
$3,960.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,700.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,700.00
|
|
|
HC MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
5102370001
|
|
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 MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
5102370001
|
|
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 MODERATE SEDATION < 5 YEARS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
9839915501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$172.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC MODERATE SEDATION < 5 YEARS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
9839915501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$151.52
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$159.50
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
3709915701
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
3709915701
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC MOD SED PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
3709915601
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
