|
HC NEUROSURGICAL PROCEDURE
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
3600000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$562.02 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$999.60
|
| Rate for Payer: Aetna of WY Medicare |
$673.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$979.20
|
| Rate for Payer: Altius Commercial |
$979.20
|
| Rate for Payer: Beech Street Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$837.42
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$989.40
|
| Rate for Payer: Cigna of WY Commercial |
$999.60
|
| Rate for Payer: Entrust Commercial |
$969.00
|
| Rate for Payer: First Choice Health Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.60
|
| Rate for Payer: HealthUtah PPO |
$1,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$989.40
|
| Rate for Payer: Multiplan Medicare/VA |
$562.02
|
| Rate for Payer: One Health Plan of WY PPO |
$999.60
|
| Rate for Payer: PacificSource Commercial |
$918.00
|
| Rate for Payer: PHCS PPO |
$999.60
|
| Rate for Payer: Three Rivers PPO |
$765.00
|
| Rate for Payer: TriWest Veterans Administration |
$591.60
|
| Rate for Payer: United Healthcare Commercial |
$887.40
|
| Rate for Payer: United Healthcare Medicare |
$591.60
|
| Rate for Payer: WINHealth Partners Commercial |
$999.60
|
| Rate for Payer: Wise Provider Network Commercial |
$969.00
|
|
|
HC NEUROSURGICAL PROCEDURE
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
3600000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.54 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$999.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$979.20
|
| Rate for Payer: Altius Commercial |
$979.20
|
| Rate for Payer: Beech Street Commercial |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$837.42
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$989.40
|
| Rate for Payer: Cigna of WY Commercial |
$999.60
|
| Rate for Payer: Entrust Commercial |
$969.00
|
| Rate for Payer: First Choice Health Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$673.20
|
| Rate for Payer: HealthUtah PPO |
$1,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$989.40
|
| Rate for Payer: Multiplan Medicare/VA |
$639.54
|
| Rate for Payer: One Health Plan of WY PPO |
$999.60
|
| Rate for Payer: PacificSource Commercial |
$918.00
|
| Rate for Payer: PHCS PPO |
$999.60
|
| Rate for Payer: Three Rivers PPO |
$765.00
|
| Rate for Payer: TriWest Veterans Administration |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$887.40
|
| Rate for Payer: United Healthcare Medicare |
$673.20
|
| Rate for Payer: WINHealth Partners Commercial |
$969.00
|
| Rate for Payer: Wise Provider Network Commercial |
$969.00
|
|
|
HC NEWBORN METABOLIC SCREENING PANEL
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS S3620
|
| Hospital Charge Code |
300S362001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.20
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$49.59
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$52.20
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC NEWBORN METABOLIC SCREENING PANEL
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS S3620
|
| Hospital Charge Code |
300S362001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.40
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.43
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3068759101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3068759101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
3204753101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9,718.50 |
| Max. Negotiated Rate |
$15,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15,190.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,880.00
|
| Rate for Payer: Altius Commercial |
$14,880.00
|
| Rate for Payer: Beech Street Commercial |
$15,190.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,725.50
|
| Rate for Payer: Cash Price |
$10,850.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,035.00
|
| Rate for Payer: Cigna of WY Commercial |
$15,190.00
|
| Rate for Payer: Entrust Commercial |
$14,725.00
|
| Rate for Payer: First Choice Health Commercial |
$14,725.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,725.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,230.00
|
| Rate for Payer: HealthUtah PPO |
$15,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,035.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9,718.50
|
| Rate for Payer: One Health Plan of WY PPO |
$15,190.00
|
| Rate for Payer: PacificSource Commercial |
$13,950.00
|
| Rate for Payer: PHCS PPO |
$15,190.00
|
| Rate for Payer: Three Rivers PPO |
$11,625.00
|
| Rate for Payer: TriWest Veterans Administration |
$10,230.00
|
| Rate for Payer: United Healthcare Commercial |
$13,485.00
|
| Rate for Payer: United Healthcare Medicare |
$10,230.00
|
| Rate for Payer: WINHealth Partners Commercial |
$14,725.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14,725.00
|
|
|
HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
3204753101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,540.50 |
| Max. Negotiated Rate |
$15,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15,190.00
|
| Rate for Payer: Aetna of WY Medicare |
$10,230.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,880.00
|
| Rate for Payer: Altius Commercial |
$14,880.00
|
| Rate for Payer: Beech Street Commercial |
$15,190.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,725.50
|
| Rate for Payer: Cash Price |
$10,850.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,035.00
|
| Rate for Payer: Cigna of WY Commercial |
$15,190.00
|
| Rate for Payer: Entrust Commercial |
$14,725.00
|
| Rate for Payer: First Choice Health Commercial |
$14,725.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,725.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,990.00
|
| Rate for Payer: HealthUtah PPO |
$15,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,035.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8,540.50
|
| Rate for Payer: One Health Plan of WY PPO |
$15,190.00
|
| Rate for Payer: PacificSource Commercial |
$13,950.00
|
| Rate for Payer: PHCS PPO |
$15,190.00
|
| Rate for Payer: Three Rivers PPO |
$11,625.00
|
| Rate for Payer: TriWest Veterans Administration |
$8,990.00
|
| Rate for Payer: United Healthcare Commercial |
$13,485.00
|
| Rate for Payer: United Healthcare Medicare |
$8,990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$15,190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14,725.00
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
3206232101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,943.70 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,976.00
|
| Rate for Payer: Altius Commercial |
$2,976.00
|
| Rate for Payer: Beech Street Commercial |
$3,038.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,545.10
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.00
|
| Rate for Payer: Entrust Commercial |
$2,945.00
|
| Rate for Payer: First Choice Health Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,046.00
|
| Rate for Payer: HealthUtah PPO |
$3,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,943.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.00
|
| Rate for Payer: PacificSource Commercial |
$2,790.00
|
| Rate for Payer: PHCS PPO |
$3,038.00
|
| Rate for Payer: Three Rivers PPO |
$2,325.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,046.00
|
| Rate for Payer: United Healthcare Commercial |
$2,697.00
|
| Rate for Payer: United Healthcare Medicare |
$2,046.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,945.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,945.00
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
3206232101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,708.10 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,046.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,976.00
|
| Rate for Payer: Altius Commercial |
$2,976.00
|
| Rate for Payer: Beech Street Commercial |
$3,038.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,545.10
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.00
|
| Rate for Payer: Entrust Commercial |
$2,945.00
|
| Rate for Payer: First Choice Health Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,798.00
|
| Rate for Payer: HealthUtah PPO |
$3,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,708.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.00
|
| Rate for Payer: PacificSource Commercial |
$2,790.00
|
| Rate for Payer: PHCS PPO |
$3,038.00
|
| Rate for Payer: Three Rivers PPO |
$2,325.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,798.00
|
| Rate for Payer: United Healthcare Commercial |
$2,697.00
|
| Rate for Payer: United Healthcare Medicare |
$1,798.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,038.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,945.00
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 62324
|
| Hospital Charge Code |
7616232401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 62324
|
| Hospital Charge Code |
7616232401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Facility
|
OP
|
$4,235.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
3206232001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,333.48 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,150.30
|
| Rate for Payer: Aetna of WY Medicare |
$2,795.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,065.60
|
| Rate for Payer: Altius Commercial |
$4,065.60
|
| Rate for Payer: Beech Street Commercial |
$4,150.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,476.94
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,107.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,150.30
|
| Rate for Payer: Entrust Commercial |
$4,023.25
|
| Rate for Payer: First Choice Health Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,456.30
|
| Rate for Payer: HealthUtah PPO |
$4,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,107.95
|
| Rate for Payer: Multiplan Medicare/VA |
$2,333.48
|
| Rate for Payer: One Health Plan of WY PPO |
$4,150.30
|
| Rate for Payer: PacificSource Commercial |
$3,811.50
|
| Rate for Payer: PHCS PPO |
$4,150.30
|
| Rate for Payer: Three Rivers PPO |
$3,176.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,456.30
|
| Rate for Payer: United Healthcare Commercial |
$3,684.45
|
| Rate for Payer: United Healthcare Medicare |
$2,456.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,150.30
|
| Rate for Payer: Wise Provider Network Commercial |
$4,023.25
|
|
|
HC NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
|
Facility
|
IP
|
$4,235.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
3206232001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,655.34 |
| Max. Negotiated Rate |
$4,235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,150.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,065.60
|
| Rate for Payer: Altius Commercial |
$4,065.60
|
| Rate for Payer: Beech Street Commercial |
$4,150.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,476.94
|
| Rate for Payer: Cash Price |
$2,964.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,107.95
|
| Rate for Payer: Cigna of WY Commercial |
$4,150.30
|
| Rate for Payer: Entrust Commercial |
$4,023.25
|
| Rate for Payer: First Choice Health Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,023.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,795.10
|
| Rate for Payer: HealthUtah PPO |
$4,235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,107.95
|
| Rate for Payer: Multiplan Medicare/VA |
$2,655.34
|
| Rate for Payer: One Health Plan of WY PPO |
$4,150.30
|
| Rate for Payer: PacificSource Commercial |
$3,811.50
|
| Rate for Payer: PHCS PPO |
$4,150.30
|
| Rate for Payer: Three Rivers PPO |
$3,176.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,795.10
|
| Rate for Payer: United Healthcare Commercial |
$3,684.45
|
| Rate for Payer: United Healthcare Medicare |
$2,795.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,023.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,023.25
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
5106232301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$322.28 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$493.44
|
| Rate for Payer: Altius Commercial |
$493.44
|
| Rate for Payer: Beech Street Commercial |
$503.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.99
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: Entrust Commercial |
$488.30
|
| Rate for Payer: First Choice Health Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.24
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$322.28
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$503.72
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$339.24
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$339.24
|
| Rate for Payer: WINHealth Partners Commercial |
$488.30
|
| Rate for Payer: Wise Provider Network Commercial |
$488.30
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
HCPCS 62323 50
|
| Hospital Charge Code |
5106232301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$1,027.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,006.46
|
| Rate for Payer: Aetna of WY Medicare |
$677.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$985.92
|
| Rate for Payer: Altius Commercial |
$985.92
|
| Rate for Payer: Beech Street Commercial |
$1,006.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$843.17
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$996.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,006.46
|
| Rate for Payer: Entrust Commercial |
$975.65
|
| Rate for Payer: First Choice Health Commercial |
$975.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$975.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$595.66
|
| Rate for Payer: HealthUtah PPO |
$1,027.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$996.19
|
| Rate for Payer: Multiplan Medicare/VA |
$565.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,006.46
|
| Rate for Payer: PacificSource Commercial |
$924.30
|
| Rate for Payer: PHCS PPO |
$1,006.46
|
| Rate for Payer: Three Rivers PPO |
$770.25
|
| Rate for Payer: TriWest Veterans Administration |
$595.66
|
| Rate for Payer: United Healthcare Commercial |
$893.49
|
| Rate for Payer: United Healthcare Medicare |
$595.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,006.46
|
| Rate for Payer: Wise Provider Network Commercial |
$975.65
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
HCPCS 62323 50
|
| Hospital Charge Code |
5106232301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$643.93 |
| Max. Negotiated Rate |
$1,027.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,006.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$985.92
|
| Rate for Payer: Altius Commercial |
$985.92
|
| Rate for Payer: Beech Street Commercial |
$1,006.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$843.17
|
| Rate for Payer: Cash Price |
$718.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$996.19
|
| Rate for Payer: Cigna of WY Commercial |
$1,006.46
|
| Rate for Payer: Entrust Commercial |
$975.65
|
| Rate for Payer: First Choice Health Commercial |
$975.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$975.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$677.82
|
| Rate for Payer: HealthUtah PPO |
$1,027.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$996.19
|
| Rate for Payer: Multiplan Medicare/VA |
$643.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,006.46
|
| Rate for Payer: PacificSource Commercial |
$924.30
|
| Rate for Payer: PHCS PPO |
$1,006.46
|
| Rate for Payer: Three Rivers PPO |
$770.25
|
| Rate for Payer: TriWest Veterans Administration |
$677.82
|
| Rate for Payer: United Healthcare Commercial |
$893.49
|
| Rate for Payer: United Healthcare Medicare |
$677.82
|
| Rate for Payer: WINHealth Partners Commercial |
$975.65
|
| Rate for Payer: Wise Provider Network Commercial |
$975.65
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
5106232301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.21 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$339.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$493.44
|
| Rate for Payer: Altius Commercial |
$493.44
|
| Rate for Payer: Beech Street Commercial |
$503.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.99
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: Entrust Commercial |
$488.30
|
| Rate for Payer: First Choice Health Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.12
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$283.21
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$503.72
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.12
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$298.12
|
| Rate for Payer: WINHealth Partners Commercial |
$503.72
|
| Rate for Payer: Wise Provider Network Commercial |
$488.30
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
3206232301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,542.80 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,848.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,624.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,624.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,624.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,744.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
3206232301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,755.60 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,848.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,755.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,848.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,848.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,660.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62323 50
|
| Hospital Charge Code |
3206232301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,542.80 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,848.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,624.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,624.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,624.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,744.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62323 50
|
| Hospital Charge Code |
3206232301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,755.60 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,848.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,755.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,848.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,848.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,660.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
3506232301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,140.57 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,028.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,366.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,987.20
|
| Rate for Payer: Altius Commercial |
$1,987.20
|
| Rate for Payer: Beech Street Commercial |
$2,028.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,699.47
|
| Rate for Payer: Cash Price |
$1,449.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,007.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,028.60
|
| Rate for Payer: Entrust Commercial |
$1,966.50
|
| Rate for Payer: First Choice Health Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,200.60
|
| Rate for Payer: HealthUtah PPO |
$2,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,007.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,140.57
|
| Rate for Payer: One Health Plan of WY PPO |
$2,028.60
|
| Rate for Payer: PacificSource Commercial |
$1,863.00
|
| Rate for Payer: PHCS PPO |
$2,028.60
|
| Rate for Payer: Three Rivers PPO |
$1,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,200.60
|
| Rate for Payer: United Healthcare Commercial |
$1,800.90
|
| Rate for Payer: United Healthcare Medicare |
$1,200.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,028.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,966.50
|
|
|
HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
3506232301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,297.89 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,028.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,987.20
|
| Rate for Payer: Altius Commercial |
$1,987.20
|
| Rate for Payer: Beech Street Commercial |
$2,028.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,699.47
|
| Rate for Payer: Cash Price |
$1,449.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,007.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,028.60
|
| Rate for Payer: Entrust Commercial |
$1,966.50
|
| Rate for Payer: First Choice Health Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,366.20
|
| Rate for Payer: HealthUtah PPO |
$2,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,007.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,297.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,028.60
|
| Rate for Payer: PacificSource Commercial |
$1,863.00
|
| Rate for Payer: PHCS PPO |
$2,028.60
|
| Rate for Payer: Three Rivers PPO |
$1,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,366.20
|
| Rate for Payer: United Healthcare Commercial |
$1,800.90
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,966.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,966.50
|
|
|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
