|
HC PARTICLE AGGLUTINATION SCREEN - STREP PNEUMONIAE AG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - STREP PNEUMONIAE AG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
3028674701
|
|
Hospital Revenue Code
|
302
|
| 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 PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
3028674701
|
|
Hospital Revenue Code
|
302
|
| 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 PATH CONSULT IN SURG,W FRZ SEC
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 88331
|
| Hospital Charge Code |
3108833101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$534.47 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Aetna of WY Medicare |
$640.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.60
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$534.47
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.60
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$562.60
|
| Rate for Payer: WINHealth Partners Commercial |
$950.60
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC PATH CONSULT IN SURG,W FRZ SEC
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 88331
|
| Hospital Charge Code |
3108833101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$608.19 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.20
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$608.19
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$640.20
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$640.20
|
| Rate for Payer: WINHealth Partners Commercial |
$921.50
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC PATH CONSULT INTRAOP ADDL - LAB PATH CONSULT IN SURG,W ADDN FRZ SEC
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 88332
|
| Hospital Charge Code |
3128833203
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC PATH CONSULT INTRAOP ADDL - LAB PATH CONSULT IN SURG,W ADDN FRZ SEC
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 88332
|
| Hospital Charge Code |
3128833203
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC PATHOGEN REDUCED PLASMA POOL FROZEN EA UNIT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS P9070
|
| Hospital Charge Code |
390P907001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC PATHOGEN REDUCED PLASMA POOL FROZEN EA UNIT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS P9070
|
| Hospital Charge Code |
390P907001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 80503
|
| Hospital Charge Code |
3018050301
|
|
Hospital Revenue Code
|
301
|
| 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 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 80503
|
| Hospital Charge Code |
3018050301
|
|
Hospital Revenue Code
|
301
|
| 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 PBB GEL-ONE
|
Facility
|
OP
|
$2,597.00
|
|
|
Service Code
|
HCPCS J7326
|
| Hospital Charge Code |
636J732601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,430.95 |
| Max. Negotiated Rate |
$2,597.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,545.06
|
| Rate for Payer: Aetna of WY Medicare |
$1,714.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,493.12
|
| Rate for Payer: Altius Commercial |
$2,493.12
|
| Rate for Payer: Beech Street Commercial |
$2,545.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,132.14
|
| Rate for Payer: Cash Price |
$1,817.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,519.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,545.06
|
| Rate for Payer: Entrust Commercial |
$2,467.15
|
| Rate for Payer: First Choice Health Commercial |
$2,467.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,467.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,506.26
|
| Rate for Payer: HealthUtah PPO |
$2,597.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,519.09
|
| Rate for Payer: Multiplan Medicare/VA |
$1,430.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,545.06
|
| Rate for Payer: PacificSource Commercial |
$2,337.30
|
| Rate for Payer: PHCS PPO |
$2,545.06
|
| Rate for Payer: Three Rivers PPO |
$1,947.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,506.26
|
| Rate for Payer: United Healthcare Commercial |
$2,259.39
|
| Rate for Payer: United Healthcare Medicare |
$1,506.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,545.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2,467.15
|
|
|
HC PBB GEL-ONE
|
Facility
|
IP
|
$2,597.00
|
|
|
Service Code
|
HCPCS J7326
|
| Hospital Charge Code |
636J732601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,628.32 |
| Max. Negotiated Rate |
$2,597.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,545.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,493.12
|
| Rate for Payer: Altius Commercial |
$2,493.12
|
| Rate for Payer: Beech Street Commercial |
$2,545.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,132.14
|
| Rate for Payer: Cash Price |
$1,817.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,519.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,545.06
|
| Rate for Payer: Entrust Commercial |
$2,467.15
|
| Rate for Payer: First Choice Health Commercial |
$2,467.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,467.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,714.02
|
| Rate for Payer: HealthUtah PPO |
$2,597.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,519.09
|
| Rate for Payer: Multiplan Medicare/VA |
$1,628.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,545.06
|
| Rate for Payer: PacificSource Commercial |
$2,337.30
|
| Rate for Payer: PHCS PPO |
$2,545.06
|
| Rate for Payer: Three Rivers PPO |
$1,947.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,714.02
|
| Rate for Payer: United Healthcare Commercial |
$2,259.39
|
| Rate for Payer: United Healthcare Medicare |
$1,714.02
|
| Rate for Payer: WINHealth Partners Commercial |
$2,467.15
|
| Rate for Payer: Wise Provider Network Commercial |
$2,467.15
|
|
|
HC PBB OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
5109921101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC PBB OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
5109921101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$25.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$25.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC PBB OFFICE OUTPATIENT NEW 15-29 MINUTES
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
5109920201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$77.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC PBB OFFICE OUTPATIENT NEW 15-29 MINUTES
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
5109920201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC PBB OFFICE OUTPATIENT NEW 30 MINUTES
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
5109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.94
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$36.99
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.94
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$38.94
|
| Rate for Payer: WINHealth Partners Commercial |
$56.05
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC PBB OFFICE OUTPATIENT NEW 30 MINUTES
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
5109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.51 |
| Max. Negotiated Rate |
$115.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$38.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.22
|
| Rate for Payer: HealthUtah PPO |
$115.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$32.51
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.22
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$34.22
|
| Rate for Payer: WINHealth Partners Commercial |
$57.82
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC PBB OFFICE OUTPATIENT NEW 45-59 MINUTES
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 99204
|
| Hospital Charge Code |
5109920401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.46
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$50.79
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.46
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$53.46
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC PBB OFFICE OUTPATIENT NEW 45-59 MINUTES
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 99204
|
| Hospital Charge Code |
5109920401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$164.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$53.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.98
|
| Rate for Payer: HealthUtah PPO |
$164.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$44.63
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$46.98
|
| Rate for Payer: WINHealth Partners Commercial |
$79.38
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC PBB OFFICE OUTPATIENT NEW 60 MINUTES
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
5109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$210.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.22
|
| Rate for Payer: HealthUtah PPO |
$210.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.06
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$63.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC PBB OFFICE OUTPATIENT NEW 60 MINUTES
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
5109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.94
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.34
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$71.94
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC PBB OFFICE OUTPATIENT VISIT 10 MINUTES
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
5109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.48
|
| Rate for Payer: Aetna of WY Medicare |
$17.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.96
|
| Rate for Payer: Altius Commercial |
$24.96
|
| Rate for Payer: Beech Street Commercial |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.35
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.22
|
| Rate for Payer: Cigna of WY Commercial |
$25.48
|
| Rate for Payer: Entrust Commercial |
$24.70
|
| Rate for Payer: First Choice Health Commercial |
$24.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.08
|
| Rate for Payer: HealthUtah PPO |
$45.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.22
|
| Rate for Payer: Multiplan Medicare/VA |
$14.33
|
| Rate for Payer: One Health Plan of WY PPO |
$25.48
|
| Rate for Payer: PacificSource Commercial |
$23.40
|
| Rate for Payer: PHCS PPO |
$25.48
|
| Rate for Payer: Three Rivers PPO |
$19.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$22.62
|
| Rate for Payer: United Healthcare Medicare |
$15.08
|
| Rate for Payer: WINHealth Partners Commercial |
$25.48
|
| Rate for Payer: Wise Provider Network Commercial |
$24.70
|
|
