|
HC OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
4027681601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.97 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Aetna of WY Medicare |
$310.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$258.97
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$272.60
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$272.60
|
| Rate for Payer: WINHealth Partners Commercial |
$460.60
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC OB US FOLLOW-UP PER FETUS - US OB FOLLOW UP TRANSABDOMINAL APPROACH
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
4027681601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.20
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$294.69
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$310.20
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$310.20
|
| Rate for Payer: WINHealth Partners Commercial |
$446.50
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
4027681501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$386.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.30
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$322.34
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$339.30
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$339.30
|
| Rate for Payer: WINHealth Partners Commercial |
$573.30
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC OB US LIMITED FETUS(S) - US OB LIMITED 1+ FETUSES
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
4027681501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.10
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$366.80
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$386.10
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$386.10
|
| Rate for Payer: WINHealth Partners Commercial |
$555.75
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 99211 NONPBBPAYER
|
| Hospital Charge Code |
9839921101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$78.72
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.32
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.12
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$51.41
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.12
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$54.12
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 99211 NONPBBPAYER
|
| Hospital Charge Code |
9839921101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$80.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$54.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$78.72
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.32
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.56
|
| Rate for Payer: HealthUtah PPO |
$25.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$45.18
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.56
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$47.56
|
| Rate for Payer: WINHealth Partners Commercial |
$80.36
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
9839921101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Medicare |
$43.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.36
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$25.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$36.37
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$38.28
|
| Rate for Payer: WINHealth Partners Commercial |
$64.68
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
4209921101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$156.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$25.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
4209921101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
9839921101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.36
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.56
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$41.38
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$43.56
|
| Rate for Payer: WINHealth Partners Commercial |
$62.70
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
9409921101
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
9409921101
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$25.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 99201
|
| Hospital Charge Code |
9839920101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Aetna of WY Medicare |
$77.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$113.28
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.88
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.44
|
| Rate for Payer: HealthUtah PPO |
$42.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$65.02
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$68.44
|
| Rate for Payer: United Healthcare Commercial |
$102.66
|
| Rate for Payer: United Healthcare Medicare |
$68.44
|
| Rate for Payer: WINHealth Partners Commercial |
$115.64
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC OFFICE OUTPATIENT NEW 10 MINUTES
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 99201
|
| Hospital Charge Code |
9839920101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$113.28
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.88
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.88
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$73.99
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$77.88
|
| Rate for Payer: United Healthcare Commercial |
$102.66
|
| Rate for Payer: United Healthcare Medicare |
$77.88
|
| Rate for Payer: WINHealth Partners Commercial |
$112.10
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC OFFICE OUTPATIENT VISIT EST 10-19 MINUTES
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
4209921201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.40
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$150.48
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$158.40
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC OFFICE OUTPATIENT VISIT EST 10-19 MINUTES
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
4209921201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$158.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.20
|
| Rate for Payer: HealthUtah PPO |
$45.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$132.24
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: WINHealth Partners Commercial |
$235.20
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
9839921501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$316.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$213.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$310.08
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$265.18
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.34
|
| Rate for Payer: HealthUtah PPO |
$146.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$177.97
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$187.34
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$187.34
|
| Rate for Payer: WINHealth Partners Commercial |
$316.54
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 99215 NONPBBPAYER
|
| Hospital Charge Code |
9839921501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$395.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$266.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$387.84
|
| Rate for Payer: Altius Commercial |
$387.84
|
| Rate for Payer: Beech Street Commercial |
$395.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$331.68
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: Entrust Commercial |
$383.80
|
| Rate for Payer: First Choice Health Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.32
|
| Rate for Payer: HealthUtah PPO |
$146.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$222.60
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$395.92
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$234.32
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$234.32
|
| Rate for Payer: WINHealth Partners Commercial |
$395.92
|
| Rate for Payer: Wise Provider Network Commercial |
$383.80
|
|
|
HC OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
9839921501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$202.52 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$310.08
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$265.18
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.18
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$202.52
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$213.18
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$213.18
|
| Rate for Payer: WINHealth Partners Commercial |
$306.85
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 99215 NONPBBPAYER
|
| Hospital Charge Code |
9839921501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$253.31 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$387.84
|
| Rate for Payer: Altius Commercial |
$387.84
|
| Rate for Payer: Beech Street Commercial |
$395.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$331.68
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: Entrust Commercial |
$383.80
|
| Rate for Payer: First Choice Health Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.64
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$253.31
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$395.92
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$266.64
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$266.64
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
| Rate for Payer: Wise Provider Network Commercial |
$383.80
|
|
|
HC OLIGOCLONAL IMMUNOGLOBULIN - OLIGOCLONAL BANDING
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
3018391601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC OLIGOCLONAL IMMUNOGLOBULIN - OLIGOCLONAL BANDING
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
3018391601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
5102781401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
5102781401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
5102778401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$377.45 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$577.92
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$494.24
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$397.32
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$377.45
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$397.32
|
| Rate for Payer: United Healthcare Commercial |
$523.74
|
| Rate for Payer: United Healthcare Medicare |
$397.32
|
| Rate for Payer: WINHealth Partners Commercial |
$571.90
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
