|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT RT
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED BIOPSY CHEST
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700219
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED BIOPSY CHEST
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700219
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$418.76 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$744.80
|
| Rate for Payer: Aetna of WY Medicare |
$501.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$729.60
|
| Rate for Payer: Altius Commercial |
$729.60
|
| Rate for Payer: Beech Street Commercial |
$744.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.96
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$737.20
|
| Rate for Payer: Cigna of WY Commercial |
$744.80
|
| Rate for Payer: Entrust Commercial |
$722.00
|
| Rate for Payer: First Choice Health Commercial |
$722.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$722.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.80
|
| Rate for Payer: HealthUtah PPO |
$760.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$737.20
|
| Rate for Payer: Multiplan Medicare/VA |
$418.76
|
| Rate for Payer: One Health Plan of WY PPO |
$744.80
|
| Rate for Payer: PacificSource Commercial |
$684.00
|
| Rate for Payer: PHCS PPO |
$744.80
|
| Rate for Payer: Three Rivers PPO |
$570.00
|
| Rate for Payer: TriWest Veterans Administration |
$440.80
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare |
$440.80
|
| Rate for Payer: WINHealth Partners Commercial |
$744.80
|
| Rate for Payer: Wise Provider Network Commercial |
$722.00
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$744.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$729.60
|
| Rate for Payer: Altius Commercial |
$729.60
|
| Rate for Payer: Beech Street Commercial |
$744.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.96
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$737.20
|
| Rate for Payer: Cigna of WY Commercial |
$744.80
|
| Rate for Payer: Entrust Commercial |
$722.00
|
| Rate for Payer: First Choice Health Commercial |
$722.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$722.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.60
|
| Rate for Payer: HealthUtah PPO |
$760.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$737.20
|
| Rate for Payer: Multiplan Medicare/VA |
$476.52
|
| Rate for Payer: One Health Plan of WY PPO |
$744.80
|
| Rate for Payer: PacificSource Commercial |
$684.00
|
| Rate for Payer: PHCS PPO |
$744.80
|
| Rate for Payer: Three Rivers PPO |
$570.00
|
| Rate for Payer: TriWest Veterans Administration |
$501.60
|
| Rate for Payer: United Healthcare Commercial |
$661.20
|
| Rate for Payer: United Healthcare Medicare |
$501.60
|
| Rate for Payer: WINHealth Partners Commercial |
$722.00
|
| Rate for Payer: Wise Provider Network Commercial |
$722.00
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
5109760501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.56
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.61
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.76
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$53.92
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.76
|
| Rate for Payer: United Healthcare Commercial |
$74.82
|
| Rate for Payer: United Healthcare Medicare |
$56.76
|
| Rate for Payer: WINHealth Partners Commercial |
$81.70
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
5109760501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$56.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.56
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.61
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.88
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$47.39
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$49.88
|
| Rate for Payer: United Healthcare Commercial |
$74.82
|
| Rate for Payer: United Healthcare Medicare |
$49.88
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
9409760501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$329.18 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$329.18
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
| Rate for Payer: WINHealth Partners Commercial |
$498.75
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
9409760501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$289.28 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$289.28
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$304.50
|
| Rate for Payer: WINHealth Partners Commercial |
$514.50
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
5109760601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$267.84
|
| Rate for Payer: Altius Commercial |
$267.84
|
| Rate for Payer: Beech Street Commercial |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$270.63
|
| Rate for Payer: Cigna of WY Commercial |
$273.42
|
| Rate for Payer: Entrust Commercial |
$265.05
|
| Rate for Payer: First Choice Health Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.14
|
| Rate for Payer: HealthUtah PPO |
$279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$270.63
|
| Rate for Payer: Multiplan Medicare/VA |
$174.93
|
| Rate for Payer: One Health Plan of WY PPO |
$273.42
|
| Rate for Payer: PacificSource Commercial |
$251.10
|
| Rate for Payer: PHCS PPO |
$273.42
|
| Rate for Payer: Three Rivers PPO |
$209.25
|
| Rate for Payer: TriWest Veterans Administration |
$184.14
|
| Rate for Payer: United Healthcare Commercial |
$242.73
|
| Rate for Payer: United Healthcare Medicare |
$184.14
|
| Rate for Payer: WINHealth Partners Commercial |
$265.05
|
| Rate for Payer: Wise Provider Network Commercial |
$265.05
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
5109760601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.73 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.42
|
| Rate for Payer: Aetna of WY Medicare |
$184.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$267.84
|
| Rate for Payer: Altius Commercial |
$267.84
|
| Rate for Payer: Beech Street Commercial |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.06
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$270.63
|
| Rate for Payer: Cigna of WY Commercial |
$273.42
|
| Rate for Payer: Entrust Commercial |
$265.05
|
| Rate for Payer: First Choice Health Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.82
|
| Rate for Payer: HealthUtah PPO |
$279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$270.63
|
| Rate for Payer: Multiplan Medicare/VA |
$153.73
|
| Rate for Payer: One Health Plan of WY PPO |
$273.42
|
| Rate for Payer: PacificSource Commercial |
$251.10
|
| Rate for Payer: PHCS PPO |
$273.42
|
| Rate for Payer: Three Rivers PPO |
$209.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.82
|
| Rate for Payer: United Healthcare Commercial |
$242.73
|
| Rate for Payer: United Healthcare Medicare |
$161.82
|
| Rate for Payer: WINHealth Partners Commercial |
$273.42
|
| Rate for Payer: Wise Provider Network Commercial |
$265.05
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
7619760601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.20 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,568.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,536.00
|
| Rate for Payer: Altius Commercial |
$1,536.00
|
| Rate for Payer: Beech Street Commercial |
$1,568.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,552.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,568.00
|
| Rate for Payer: Entrust Commercial |
$1,520.00
|
| Rate for Payer: First Choice Health Commercial |
$1,520.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,520.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,056.00
|
| Rate for Payer: HealthUtah PPO |
$1,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,552.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,003.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,568.00
|
| Rate for Payer: PacificSource Commercial |
$1,440.00
|
| Rate for Payer: PHCS PPO |
$1,568.00
|
| Rate for Payer: Three Rivers PPO |
$1,200.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,056.00
|
| Rate for Payer: United Healthcare Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare Medicare |
$1,056.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,520.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,520.00
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
7619760601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$881.60 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,568.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,056.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,536.00
|
| Rate for Payer: Altius Commercial |
$1,536.00
|
| Rate for Payer: Beech Street Commercial |
$1,568.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,313.60
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,552.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,568.00
|
| Rate for Payer: Entrust Commercial |
$1,520.00
|
| Rate for Payer: First Choice Health Commercial |
$1,520.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,520.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$928.00
|
| Rate for Payer: HealthUtah PPO |
$1,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,552.00
|
| Rate for Payer: Multiplan Medicare/VA |
$881.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,568.00
|
| Rate for Payer: PacificSource Commercial |
$1,440.00
|
| Rate for Payer: PHCS PPO |
$1,568.00
|
| Rate for Payer: Three Rivers PPO |
$1,200.00
|
| Rate for Payer: TriWest Veterans Administration |
$928.00
|
| Rate for Payer: United Healthcare Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare Medicare |
$928.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,568.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,520.00
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME <= 50 SQ CM
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
5109760701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME <= 50 SQ CM
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
5109760701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - IMMUNOGLOBULIN FREE LT CHAINS BLOOD
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - IMMUNOGLOBULIN FREE LT CHAINS BLOOD
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS, URINE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS, URINE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3018388302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
9229591001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$790.02 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,209.60
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,034.46
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.60
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$790.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare Medicare |
$831.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
HC NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
9229591001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$694.26 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,234.80
|
| Rate for Payer: Aetna of WY Medicare |
$831.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,209.60
|
| Rate for Payer: Altius Commercial |
$1,209.60
|
| Rate for Payer: Beech Street Commercial |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,034.46
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,222.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,234.80
|
| Rate for Payer: Entrust Commercial |
$1,197.00
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$730.80
|
| Rate for Payer: HealthUtah PPO |
$1,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,222.20
|
| Rate for Payer: Multiplan Medicare/VA |
$694.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,234.80
|
| Rate for Payer: PacificSource Commercial |
$1,134.00
|
| Rate for Payer: PHCS PPO |
$1,234.80
|
| Rate for Payer: Three Rivers PPO |
$945.00
|
| Rate for Payer: TriWest Veterans Administration |
$730.80
|
| Rate for Payer: United Healthcare Commercial |
$1,096.20
|
| Rate for Payer: United Healthcare Medicare |
$730.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.00
|
|
|
HC NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
9229591101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$424.27 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$508.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$739.20
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$632.17
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$446.60
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$424.27
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$446.60
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$446.60
|
| Rate for Payer: WINHealth Partners Commercial |
$754.60
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
HC NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
9229591101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$482.79 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$739.20
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$632.17
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$508.20
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$482.79
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$508.20
|
| Rate for Payer: WINHealth Partners Commercial |
$731.50
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
HC NEURO/ORTHOPEDIC PROCEDURE
|
Facility
|
OP
|
$3,450.00
|
|
| Hospital Charge Code |
3600000030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,900.95 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,381.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,277.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,312.00
|
| Rate for Payer: Altius Commercial |
$3,312.00
|
| Rate for Payer: Beech Street Commercial |
$3,381.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,832.45
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,346.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,381.00
|
| Rate for Payer: Entrust Commercial |
$3,277.50
|
| Rate for Payer: First Choice Health Commercial |
$3,277.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,277.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,001.00
|
| Rate for Payer: HealthUtah PPO |
$3,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,346.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,900.95
|
| Rate for Payer: One Health Plan of WY PPO |
$3,381.00
|
| Rate for Payer: PacificSource Commercial |
$3,105.00
|
| Rate for Payer: PHCS PPO |
$3,381.00
|
| Rate for Payer: Three Rivers PPO |
$2,587.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,001.00
|
| Rate for Payer: United Healthcare Commercial |
$3,001.50
|
| Rate for Payer: United Healthcare Medicare |
$2,001.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,381.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,277.50
|
|
|
HC NEURO/ORTHOPEDIC PROCEDURE
|
Facility
|
IP
|
$3,450.00
|
|
| Hospital Charge Code |
3600000030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,163.15 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,381.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,312.00
|
| Rate for Payer: Altius Commercial |
$3,312.00
|
| Rate for Payer: Beech Street Commercial |
$3,381.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,832.45
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,346.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,381.00
|
| Rate for Payer: Entrust Commercial |
$3,277.50
|
| Rate for Payer: First Choice Health Commercial |
$3,277.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,277.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,277.00
|
| Rate for Payer: HealthUtah PPO |
$3,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,346.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,163.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,381.00
|
| Rate for Payer: PacificSource Commercial |
$3,105.00
|
| Rate for Payer: PHCS PPO |
$3,381.00
|
| Rate for Payer: Three Rivers PPO |
$2,587.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,277.00
|
| Rate for Payer: United Healthcare Commercial |
$3,001.50
|
| Rate for Payer: United Healthcare Medicare |
$2,277.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,277.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,277.50
|
|
