|
HC OR TIME
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
3600000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC OR TIME
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
3600000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC OR TIME CATARACT
|
Facility
|
OP
|
$1,860.00
|
|
| Hospital Charge Code |
3600000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,024.86 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,227.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,785.60
|
| Rate for Payer: Altius Commercial |
$1,785.60
|
| Rate for Payer: Beech Street Commercial |
$1,822.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,527.06
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: Entrust Commercial |
$1,767.00
|
| Rate for Payer: First Choice Health Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,078.80
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,822.80
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,078.80
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$1,078.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,822.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,767.00
|
|
|
HC OR TIME CATARACT
|
Facility
|
IP
|
$1,860.00
|
|
| Hospital Charge Code |
3600000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,166.22 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,785.60
|
| Rate for Payer: Altius Commercial |
$1,785.60
|
| Rate for Payer: Beech Street Commercial |
$1,822.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,527.06
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: Entrust Commercial |
$1,767.00
|
| Rate for Payer: First Choice Health Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,227.60
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,166.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,822.80
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,227.60
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$1,227.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,767.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,767.00
|
|
|
HC OR YAG
|
Facility
|
OP
|
$1,275.00
|
|
| Hospital Charge Code |
3600000028
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$702.52 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,249.50
|
| Rate for Payer: Aetna of WY Medicare |
$841.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,224.00
|
| Rate for Payer: Altius Commercial |
$1,224.00
|
| Rate for Payer: Beech Street Commercial |
$1,249.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,046.78
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,236.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,249.50
|
| Rate for Payer: Entrust Commercial |
$1,211.25
|
| Rate for Payer: First Choice Health Commercial |
$1,211.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,211.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.50
|
| Rate for Payer: HealthUtah PPO |
$1,275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,236.75
|
| Rate for Payer: Multiplan Medicare/VA |
$702.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,249.50
|
| Rate for Payer: PacificSource Commercial |
$1,147.50
|
| Rate for Payer: PHCS PPO |
$1,249.50
|
| Rate for Payer: Three Rivers PPO |
$956.25
|
| Rate for Payer: TriWest Veterans Administration |
$739.50
|
| Rate for Payer: United Healthcare Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare Medicare |
$739.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,249.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,211.25
|
|
|
HC OR YAG
|
Facility
|
IP
|
$1,275.00
|
|
| Hospital Charge Code |
3600000028
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.42 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,249.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,224.00
|
| Rate for Payer: Altius Commercial |
$1,224.00
|
| Rate for Payer: Beech Street Commercial |
$1,249.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,046.78
|
| Rate for Payer: Cash Price |
$892.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,236.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,249.50
|
| Rate for Payer: Entrust Commercial |
$1,211.25
|
| Rate for Payer: First Choice Health Commercial |
$1,211.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,211.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$841.50
|
| Rate for Payer: HealthUtah PPO |
$1,275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,236.75
|
| Rate for Payer: Multiplan Medicare/VA |
$799.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,249.50
|
| Rate for Payer: PacificSource Commercial |
$1,147.50
|
| Rate for Payer: PHCS PPO |
$1,249.50
|
| Rate for Payer: Three Rivers PPO |
$956.25
|
| Rate for Payer: TriWest Veterans Administration |
$841.50
|
| Rate for Payer: United Healthcare Commercial |
$1,109.25
|
| Rate for Payer: United Healthcare Medicare |
$841.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,211.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,211.25
|
|
|
HC OSTEOPATHIC MANIP,1-2 BODY REGN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
5109892501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$15.68
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$16.50
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC OSTEOPATHIC MANIP,1-2 BODY REGN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
5109892501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$13.78
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$14.50
|
| Rate for Payer: WINHealth Partners Commercial |
$24.50
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC OSTEOPATHIC MANIP,1-2 BODY REGN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
7619892501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,1-2 BODY REGN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
7619892501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,3-4 BODY REGN
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
5109892601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC OSTEOPATHIC MANIP,3-4 BODY REGN
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
5109892601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC OSTEOPATHIC MANIP,3-4 BODY REGN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
7619892601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,3-4 BODY REGN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
7619892601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,5-6 BODY REGN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
7619892701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,5-6 BODY REGN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
7619892701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OSTEOPATHIC MANIP,5-6 BODY REGN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
5109892701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.62
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC OSTEOPATHIC MANIP,5-6 BODY REGN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
5109892701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC OSTEOPATHIC MANIP,7-8 BODY REGN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
5109892801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.24
|
| Rate for Payer: Altius Commercial |
$42.24
|
| Rate for Payer: Beech Street Commercial |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.68
|
| Rate for Payer: Cigna of WY Commercial |
$43.12
|
| Rate for Payer: Entrust Commercial |
$41.80
|
| Rate for Payer: First Choice Health Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.04
|
| Rate for Payer: HealthUtah PPO |
$44.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.68
|
| Rate for Payer: Multiplan Medicare/VA |
$27.59
|
| Rate for Payer: One Health Plan of WY PPO |
$43.12
|
| Rate for Payer: PacificSource Commercial |
$39.60
|
| Rate for Payer: PHCS PPO |
$43.12
|
| Rate for Payer: Three Rivers PPO |
$33.00
|
| Rate for Payer: TriWest Veterans Administration |
$29.04
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$29.04
|
| Rate for Payer: WINHealth Partners Commercial |
$41.80
|
| Rate for Payer: Wise Provider Network Commercial |
$41.80
|
|
|
HC OSTEOPATHIC MANIP,7-8 BODY REGN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
5109892801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.12
|
| Rate for Payer: Aetna of WY Medicare |
$29.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.24
|
| Rate for Payer: Altius Commercial |
$42.24
|
| Rate for Payer: Beech Street Commercial |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.68
|
| Rate for Payer: Cigna of WY Commercial |
$43.12
|
| Rate for Payer: Entrust Commercial |
$41.80
|
| Rate for Payer: First Choice Health Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.52
|
| Rate for Payer: HealthUtah PPO |
$44.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.68
|
| Rate for Payer: Multiplan Medicare/VA |
$24.24
|
| Rate for Payer: One Health Plan of WY PPO |
$43.12
|
| Rate for Payer: PacificSource Commercial |
$39.60
|
| Rate for Payer: PHCS PPO |
$43.12
|
| Rate for Payer: Three Rivers PPO |
$33.00
|
| Rate for Payer: TriWest Veterans Administration |
$25.52
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$25.52
|
| Rate for Payer: WINHealth Partners Commercial |
$43.12
|
| Rate for Payer: Wise Provider Network Commercial |
$41.80
|
|
|
HC OSTEOPATHIC MANIP,9-10 BODY REGN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
5109892901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.12
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.02
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$29.47
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: United Healthcare Medicare |
$31.02
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC OSTEOPATHIC MANIP,9-10 BODY REGN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
5109892901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.12
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.26
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$25.90
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.26
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: United Healthcare Medicare |
$27.26
|
| Rate for Payer: WINHealth Partners Commercial |
$46.06
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC OT ACCESS
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
4200000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC OT ACCESS
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
4200000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC OT ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 97755
|
| Hospital Charge Code |
4309775501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
