|
HC PREVENTIVE VISIT,EST,18-39
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
5109939501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.63 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$182.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$265.92
|
| Rate for Payer: Altius Commercial |
$265.92
|
| Rate for Payer: Beech Street Commercial |
$271.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.42
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: Entrust Commercial |
$263.15
|
| Rate for Payer: First Choice Health Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.66
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$152.63
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$271.46
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$160.66
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$160.66
|
| Rate for Payer: WINHealth Partners Commercial |
$271.46
|
| Rate for Payer: Wise Provider Network Commercial |
$263.15
|
|
|
HC PREVENTIVE VISIT,EST,65 & OVER
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
5109939701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.82 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$335.04
|
| Rate for Payer: Altius Commercial |
$335.04
|
| Rate for Payer: Beech Street Commercial |
$342.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$286.53
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$338.53
|
| Rate for Payer: Cigna of WY Commercial |
$342.02
|
| Rate for Payer: Entrust Commercial |
$331.55
|
| Rate for Payer: First Choice Health Commercial |
$331.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$331.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$230.34
|
| Rate for Payer: HealthUtah PPO |
$349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$338.53
|
| Rate for Payer: Multiplan Medicare/VA |
$218.82
|
| Rate for Payer: One Health Plan of WY PPO |
$342.02
|
| Rate for Payer: PacificSource Commercial |
$314.10
|
| Rate for Payer: PHCS PPO |
$342.02
|
| Rate for Payer: Three Rivers PPO |
$261.75
|
| Rate for Payer: TriWest Veterans Administration |
$230.34
|
| Rate for Payer: United Healthcare Commercial |
$303.63
|
| Rate for Payer: United Healthcare Medicare |
$230.34
|
| Rate for Payer: WINHealth Partners Commercial |
$331.55
|
| Rate for Payer: Wise Provider Network Commercial |
$331.55
|
|
|
HC PREVENTIVE VISIT,EST,65 & OVER
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
5109939701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.30 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.02
|
| Rate for Payer: Aetna of WY Medicare |
$230.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$335.04
|
| Rate for Payer: Altius Commercial |
$335.04
|
| Rate for Payer: Beech Street Commercial |
$342.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$286.53
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$338.53
|
| Rate for Payer: Cigna of WY Commercial |
$342.02
|
| Rate for Payer: Entrust Commercial |
$331.55
|
| Rate for Payer: First Choice Health Commercial |
$331.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$331.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.42
|
| Rate for Payer: HealthUtah PPO |
$349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$338.53
|
| Rate for Payer: Multiplan Medicare/VA |
$192.30
|
| Rate for Payer: One Health Plan of WY PPO |
$342.02
|
| Rate for Payer: PacificSource Commercial |
$314.10
|
| Rate for Payer: PHCS PPO |
$342.02
|
| Rate for Payer: Three Rivers PPO |
$261.75
|
| Rate for Payer: TriWest Veterans Administration |
$202.42
|
| Rate for Payer: United Healthcare Commercial |
$303.63
|
| Rate for Payer: United Healthcare Medicare |
$202.42
|
| Rate for Payer: WINHealth Partners Commercial |
$342.02
|
| Rate for Payer: Wise Provider Network Commercial |
$331.55
|
|
|
HC PREVENTIVE VISIT,NEW,18-39
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
5109938501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.89 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$309.12
|
| Rate for Payer: Altius Commercial |
$309.12
|
| Rate for Payer: Beech Street Commercial |
$315.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.36
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: Entrust Commercial |
$305.90
|
| Rate for Payer: First Choice Health Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$212.52
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$201.89
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$315.56
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$212.52
|
| Rate for Payer: United Healthcare Commercial |
$280.14
|
| Rate for Payer: United Healthcare Medicare |
$212.52
|
| Rate for Payer: WINHealth Partners Commercial |
$305.90
|
| Rate for Payer: Wise Provider Network Commercial |
$305.90
|
|
|
HC PREVENTIVE VISIT,NEW,18-39
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
5109938501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.42 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$212.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$309.12
|
| Rate for Payer: Altius Commercial |
$309.12
|
| Rate for Payer: Beech Street Commercial |
$315.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.36
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: Entrust Commercial |
$305.90
|
| Rate for Payer: First Choice Health Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.76
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$177.42
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$315.56
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$186.76
|
| Rate for Payer: United Healthcare Commercial |
$280.14
|
| Rate for Payer: United Healthcare Medicare |
$186.76
|
| Rate for Payer: WINHealth Partners Commercial |
$315.56
|
| Rate for Payer: Wise Provider Network Commercial |
$305.90
|
|
|
HC PREVENTIVE VISIT,NEW,40-64
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
5109938601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.81 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$351.82
|
| Rate for Payer: Aetna of WY Medicare |
$236.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$344.64
|
| Rate for Payer: Altius Commercial |
$344.64
|
| Rate for Payer: Beech Street Commercial |
$351.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$294.74
|
| Rate for Payer: Cash Price |
$251.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$348.23
|
| Rate for Payer: Cigna of WY Commercial |
$351.82
|
| Rate for Payer: Entrust Commercial |
$341.05
|
| Rate for Payer: First Choice Health Commercial |
$341.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$341.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.22
|
| Rate for Payer: HealthUtah PPO |
$359.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$348.23
|
| Rate for Payer: Multiplan Medicare/VA |
$197.81
|
| Rate for Payer: One Health Plan of WY PPO |
$351.82
|
| Rate for Payer: PacificSource Commercial |
$323.10
|
| Rate for Payer: PHCS PPO |
$351.82
|
| Rate for Payer: Three Rivers PPO |
$269.25
|
| Rate for Payer: TriWest Veterans Administration |
$208.22
|
| Rate for Payer: United Healthcare Commercial |
$312.33
|
| Rate for Payer: United Healthcare Medicare |
$208.22
|
| Rate for Payer: WINHealth Partners Commercial |
$351.82
|
| Rate for Payer: Wise Provider Network Commercial |
$341.05
|
|
|
HC PREVENTIVE VISIT,NEW,40-64
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
5109938601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.09 |
| Max. Negotiated Rate |
$359.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$351.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$344.64
|
| Rate for Payer: Altius Commercial |
$344.64
|
| Rate for Payer: Beech Street Commercial |
$351.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$294.74
|
| Rate for Payer: Cash Price |
$251.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$348.23
|
| Rate for Payer: Cigna of WY Commercial |
$351.82
|
| Rate for Payer: Entrust Commercial |
$341.05
|
| Rate for Payer: First Choice Health Commercial |
$341.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$341.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$236.94
|
| Rate for Payer: HealthUtah PPO |
$359.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$348.23
|
| Rate for Payer: Multiplan Medicare/VA |
$225.09
|
| Rate for Payer: One Health Plan of WY PPO |
$351.82
|
| Rate for Payer: PacificSource Commercial |
$323.10
|
| Rate for Payer: PHCS PPO |
$351.82
|
| Rate for Payer: Three Rivers PPO |
$269.25
|
| Rate for Payer: TriWest Veterans Administration |
$236.94
|
| Rate for Payer: United Healthcare Commercial |
$312.33
|
| Rate for Payer: United Healthcare Medicare |
$236.94
|
| Rate for Payer: WINHealth Partners Commercial |
$341.05
|
| Rate for Payer: Wise Provider Network Commercial |
$341.05
|
|
|
HC PREVENTIVE VISIT,NEW,65 & OVER
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 99387
|
| Hospital Charge Code |
5109938701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.44 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$383.18
|
| Rate for Payer: Aetna of WY Medicare |
$258.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$375.36
|
| Rate for Payer: Altius Commercial |
$375.36
|
| Rate for Payer: Beech Street Commercial |
$383.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$321.01
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$379.27
|
| Rate for Payer: Cigna of WY Commercial |
$383.18
|
| Rate for Payer: Entrust Commercial |
$371.45
|
| Rate for Payer: First Choice Health Commercial |
$371.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$371.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.78
|
| Rate for Payer: HealthUtah PPO |
$391.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$379.27
|
| Rate for Payer: Multiplan Medicare/VA |
$215.44
|
| Rate for Payer: One Health Plan of WY PPO |
$383.18
|
| Rate for Payer: PacificSource Commercial |
$351.90
|
| Rate for Payer: PHCS PPO |
$383.18
|
| Rate for Payer: Three Rivers PPO |
$293.25
|
| Rate for Payer: TriWest Veterans Administration |
$226.78
|
| Rate for Payer: United Healthcare Commercial |
$340.17
|
| Rate for Payer: United Healthcare Medicare |
$226.78
|
| Rate for Payer: WINHealth Partners Commercial |
$383.18
|
| Rate for Payer: Wise Provider Network Commercial |
$371.45
|
|
|
HC PREVENTIVE VISIT,NEW,65 & OVER
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 99387
|
| Hospital Charge Code |
5109938701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$245.16 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$383.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$375.36
|
| Rate for Payer: Altius Commercial |
$375.36
|
| Rate for Payer: Beech Street Commercial |
$383.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$321.01
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$379.27
|
| Rate for Payer: Cigna of WY Commercial |
$383.18
|
| Rate for Payer: Entrust Commercial |
$371.45
|
| Rate for Payer: First Choice Health Commercial |
$371.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$371.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.06
|
| Rate for Payer: HealthUtah PPO |
$391.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$379.27
|
| Rate for Payer: Multiplan Medicare/VA |
$245.16
|
| Rate for Payer: One Health Plan of WY PPO |
$383.18
|
| Rate for Payer: PacificSource Commercial |
$351.90
|
| Rate for Payer: PHCS PPO |
$383.18
|
| Rate for Payer: Three Rivers PPO |
$293.25
|
| Rate for Payer: TriWest Veterans Administration |
$258.06
|
| Rate for Payer: United Healthcare Commercial |
$340.17
|
| Rate for Payer: United Healthcare Medicare |
$258.06
|
| Rate for Payer: WINHealth Partners Commercial |
$371.45
|
| Rate for Payer: Wise Provider Network Commercial |
$371.45
|
|
|
HC PRIVATE ROOM DAILY HIGH
|
Facility
|
IP
|
$8,585.00
|
|
| Hospital Charge Code |
1100000004
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$5,382.80 |
| Max. Negotiated Rate |
$8,585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,413.30
|
| Rate for Payer: Aetna of WY Medicare |
$5,494.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,241.60
|
| Rate for Payer: Altius Commercial |
$8,241.60
|
| Rate for Payer: Beech Street Commercial |
$8,413.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,048.28
|
| Rate for Payer: Cash Price |
$6,009.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,327.45
|
| Rate for Payer: Cigna of WY Commercial |
$8,413.30
|
| Rate for Payer: Entrust Commercial |
$8,155.75
|
| Rate for Payer: First Choice Health Commercial |
$8,155.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,155.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,666.10
|
| Rate for Payer: HealthUtah PPO |
$8,585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,327.45
|
| Rate for Payer: Multiplan Medicare/VA |
$5,382.80
|
| Rate for Payer: One Health Plan of WY PPO |
$8,413.30
|
| Rate for Payer: PacificSource Commercial |
$7,726.50
|
| Rate for Payer: PHCS PPO |
$8,413.30
|
| Rate for Payer: Three Rivers PPO |
$6,438.75
|
| Rate for Payer: TriWest Veterans Administration |
$5,666.10
|
| Rate for Payer: United Healthcare Commercial |
$7,468.95
|
| Rate for Payer: United Healthcare Medicare |
$5,666.10
|
| Rate for Payer: WINHealth Partners Commercial |
$8,155.75
|
| Rate for Payer: Wise Provider Network Commercial |
$8,155.75
|
|
|
HC PRIVATE ROOM DAILY LOW
|
Facility
|
IP
|
$2,740.00
|
|
| Hospital Charge Code |
1100000002
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,717.98 |
| Max. Negotiated Rate |
$2,740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,685.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,753.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,630.40
|
| Rate for Payer: Altius Commercial |
$2,630.40
|
| Rate for Payer: Beech Street Commercial |
$2,685.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,249.54
|
| Rate for Payer: Cash Price |
$1,918.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,657.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,685.20
|
| Rate for Payer: Entrust Commercial |
$2,603.00
|
| Rate for Payer: First Choice Health Commercial |
$2,603.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,603.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,808.40
|
| Rate for Payer: HealthUtah PPO |
$2,740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,657.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,717.98
|
| Rate for Payer: One Health Plan of WY PPO |
$2,685.20
|
| Rate for Payer: PacificSource Commercial |
$2,466.00
|
| Rate for Payer: PHCS PPO |
$2,685.20
|
| Rate for Payer: Three Rivers PPO |
$2,055.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,808.40
|
| Rate for Payer: United Healthcare Commercial |
$2,383.80
|
| Rate for Payer: United Healthcare Medicare |
$1,808.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,603.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,603.00
|
|
|
HC PRIVATE ROOM DAILY MED
|
Facility
|
IP
|
$7,610.00
|
|
| Hospital Charge Code |
1100000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$4,771.47 |
| Max. Negotiated Rate |
$7,610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,457.80
|
| Rate for Payer: Aetna of WY Medicare |
$4,870.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,305.60
|
| Rate for Payer: Altius Commercial |
$7,305.60
|
| Rate for Payer: Beech Street Commercial |
$7,457.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,247.81
|
| Rate for Payer: Cash Price |
$5,327.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,381.70
|
| Rate for Payer: Cigna of WY Commercial |
$7,457.80
|
| Rate for Payer: Entrust Commercial |
$7,229.50
|
| Rate for Payer: First Choice Health Commercial |
$7,229.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,229.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,022.60
|
| Rate for Payer: HealthUtah PPO |
$7,610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,381.70
|
| Rate for Payer: Multiplan Medicare/VA |
$4,771.47
|
| Rate for Payer: One Health Plan of WY PPO |
$7,457.80
|
| Rate for Payer: PacificSource Commercial |
$6,849.00
|
| Rate for Payer: PHCS PPO |
$7,457.80
|
| Rate for Payer: Three Rivers PPO |
$5,707.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,022.60
|
| Rate for Payer: United Healthcare Commercial |
$6,620.70
|
| Rate for Payer: United Healthcare Medicare |
$5,022.60
|
| Rate for Payer: WINHealth Partners Commercial |
$7,229.50
|
| Rate for Payer: Wise Provider Network Commercial |
$7,229.50
|
|
|
HC PRIVATE ROOM DAILY SWING BED SKILLED
|
Facility
|
IP
|
$4,800.00
|
|
| Hospital Charge Code |
1100000005
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$3,009.60 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,704.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,072.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,608.00
|
| Rate for Payer: Altius Commercial |
$4,608.00
|
| Rate for Payer: Beech Street Commercial |
$4,704.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,940.80
|
| Rate for Payer: Cash Price |
$3,360.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,656.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,704.00
|
| Rate for Payer: Entrust Commercial |
$4,560.00
|
| Rate for Payer: First Choice Health Commercial |
$4,560.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,560.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,168.00
|
| Rate for Payer: HealthUtah PPO |
$4,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,656.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,009.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,704.00
|
| Rate for Payer: PacificSource Commercial |
$4,320.00
|
| Rate for Payer: PHCS PPO |
$4,704.00
|
| Rate for Payer: Three Rivers PPO |
$3,600.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$4,176.00
|
| Rate for Payer: United Healthcare Medicare |
$3,168.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,560.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,560.00
|
|
|
HC PRO 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
9727637601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Aetna of WY Medicare |
$24.39
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.39
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: Multiplan Medicare/VA |
$20.73
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: TriWest Veterans Administration |
$24.39
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$24.39
|
| Rate for Payer: WINHealth Partners Commercial |
$69.35
|
|
|
HC PRO ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
9834908301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$1,389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,361.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,205.40
|
| Rate for Payer: Aetna of WY Medicare |
$100.45
|
| Rate for Payer: Aetna of WY Medicare |
$100.45
|
| Rate for Payer: Beech Street Commercial |
$1,168.50
|
| Rate for Payer: Beech Street Commercial |
$1,319.55
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,347.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,193.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,205.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,361.22
|
| Rate for Payer: First Choice Health Commercial |
$1,107.00
|
| Rate for Payer: First Choice Health Commercial |
$1,250.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,319.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.45
|
| Rate for Payer: HealthUtah PPO |
$1,389.00
|
| Rate for Payer: HealthUtah PPO |
$1,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,347.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,193.10
|
| Rate for Payer: Multiplan Medicare/VA |
$85.38
|
| Rate for Payer: Multiplan Medicare/VA |
$85.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,361.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,205.40
|
| Rate for Payer: PacificSource Commercial |
$1,107.00
|
| Rate for Payer: PacificSource Commercial |
$1,250.10
|
| Rate for Payer: PHCS PPO |
$1,319.55
|
| Rate for Payer: PHCS PPO |
$1,168.50
|
| Rate for Payer: Three Rivers PPO |
$1,041.75
|
| Rate for Payer: Three Rivers PPO |
$922.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.45
|
| Rate for Payer: TriWest Veterans Administration |
$100.45
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Commercial |
$1,208.43
|
| Rate for Payer: United Healthcare Medicare |
$100.45
|
| Rate for Payer: United Healthcare Medicare |
$100.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,180.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.50
|
|
|
HC PRO ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
9834908201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.26
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Beech Street Commercial |
$462.65
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.39
|
| Rate for Payer: Cigna of WY Commercial |
$477.26
|
| Rate for Payer: First Choice Health Commercial |
$438.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.76
|
| Rate for Payer: HealthUtah PPO |
$487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.39
|
| Rate for Payer: Multiplan Medicare/VA |
$59.30
|
| Rate for Payer: One Health Plan of WY PPO |
$477.26
|
| Rate for Payer: PacificSource Commercial |
$438.30
|
| Rate for Payer: PHCS PPO |
$462.65
|
| Rate for Payer: Three Rivers PPO |
$365.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$423.69
|
| Rate for Payer: United Healthcare Medicare |
$69.76
|
| Rate for Payer: WINHealth Partners Commercial |
$413.95
|
|
|
HC PRO ABS ARTHRO DRILLING
|
Professional
|
Both
|
$3,192.00
|
|
|
Service Code
|
HCPCS 29884
|
| Hospital Charge Code |
9832988401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$512.86 |
| Max. Negotiated Rate |
$3,192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,128.16
|
| Rate for Payer: Aetna of WY Medicare |
$603.37
|
| Rate for Payer: Beech Street Commercial |
$3,032.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,096.24
|
| Rate for Payer: Cigna of WY Commercial |
$3,128.16
|
| Rate for Payer: First Choice Health Commercial |
$2,872.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,032.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.37
|
| Rate for Payer: HealthUtah PPO |
$3,192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,096.24
|
| Rate for Payer: Multiplan Medicare/VA |
$512.86
|
| Rate for Payer: One Health Plan of WY PPO |
$3,128.16
|
| Rate for Payer: PacificSource Commercial |
$2,872.80
|
| Rate for Payer: PHCS PPO |
$3,032.40
|
| Rate for Payer: Three Rivers PPO |
$2,394.00
|
| Rate for Payer: TriWest Veterans Administration |
$603.37
|
| Rate for Payer: United Healthcare Commercial |
$2,777.04
|
| Rate for Payer: United Healthcare Medicare |
$603.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,713.20
|
|
|
HC PRO ACNE SURGERY
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
9831004001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$261.66
|
| Rate for Payer: Aetna of WY Medicare |
$49.90
|
| Rate for Payer: Beech Street Commercial |
$253.65
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.99
|
| Rate for Payer: Cigna of WY Commercial |
$261.66
|
| Rate for Payer: First Choice Health Commercial |
$240.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.90
|
| Rate for Payer: HealthUtah PPO |
$267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.99
|
| Rate for Payer: Multiplan Medicare/VA |
$42.42
|
| Rate for Payer: One Health Plan of WY PPO |
$261.66
|
| Rate for Payer: PacificSource Commercial |
$240.30
|
| Rate for Payer: PHCS PPO |
$253.65
|
| Rate for Payer: Three Rivers PPO |
$200.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.90
|
| Rate for Payer: United Healthcare Commercial |
$232.29
|
| Rate for Payer: United Healthcare Medicare |
$49.90
|
| Rate for Payer: WINHealth Partners Commercial |
$226.95
|
|
|
HC PRO ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
9834283101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$193.32 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,132.88
|
| Rate for Payer: Aetna of WY Medicare |
$227.43
|
| Rate for Payer: Beech Street Commercial |
$1,098.20
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: Cash Price |
$809.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,121.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,132.88
|
| Rate for Payer: First Choice Health Commercial |
$1,040.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,098.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.43
|
| Rate for Payer: HealthUtah PPO |
$1,156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,121.32
|
| Rate for Payer: Multiplan Medicare/VA |
$193.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,132.88
|
| Rate for Payer: PacificSource Commercial |
$1,040.40
|
| Rate for Payer: PHCS PPO |
$1,098.20
|
| Rate for Payer: Three Rivers PPO |
$867.00
|
| Rate for Payer: TriWest Veterans Administration |
$227.43
|
| Rate for Payer: United Healthcare Commercial |
$1,005.72
|
| Rate for Payer: United Healthcare Medicare |
$227.43
|
| Rate for Payer: WINHealth Partners Commercial |
$982.60
|
|
|
HC PRO ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
9834283601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$204.49 |
| Max. Negotiated Rate |
$1,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,212.26
|
| Rate for Payer: Aetna of WY Medicare |
$240.58
|
| Rate for Payer: Beech Street Commercial |
$1,175.15
|
| Rate for Payer: Cash Price |
$865.90
|
| Rate for Payer: Cash Price |
$865.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,199.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,212.26
|
| Rate for Payer: First Choice Health Commercial |
$1,113.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,175.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.58
|
| Rate for Payer: HealthUtah PPO |
$1,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,199.89
|
| Rate for Payer: Multiplan Medicare/VA |
$204.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,212.26
|
| Rate for Payer: PacificSource Commercial |
$1,113.30
|
| Rate for Payer: PHCS PPO |
$1,175.15
|
| Rate for Payer: Three Rivers PPO |
$927.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.58
|
| Rate for Payer: United Healthcare Commercial |
$1,076.19
|
| Rate for Payer: United Healthcare Medicare |
$240.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,051.45
|
|
|
HC PRO ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$3,542.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
9751402101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,471.16
|
| Rate for Payer: Aetna of WY Medicare |
$684.85
|
| Rate for Payer: Beech Street Commercial |
$3,364.90
|
| Rate for Payer: Cash Price |
$2,479.40
|
| Rate for Payer: Cash Price |
$2,479.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,435.74
|
| Rate for Payer: Cigna of WY Commercial |
$3,471.16
|
| Rate for Payer: First Choice Health Commercial |
$3,187.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,364.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.85
|
| Rate for Payer: HealthUtah PPO |
$3,542.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,435.74
|
| Rate for Payer: Multiplan Medicare/VA |
$582.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,471.16
|
| Rate for Payer: PacificSource Commercial |
$3,187.80
|
| Rate for Payer: PHCS PPO |
$3,364.90
|
| Rate for Payer: Three Rivers PPO |
$2,656.50
|
| Rate for Payer: TriWest Veterans Administration |
$684.85
|
| Rate for Payer: United Healthcare Commercial |
$3,081.54
|
| Rate for Payer: United Healthcare Medicare |
$684.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,010.70
|
|
|
HC PRO ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$3,449.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
9831402001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$467.19 |
| Max. Negotiated Rate |
$3,449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,380.02
|
| Rate for Payer: Aetna of WY Medicare |
$549.64
|
| Rate for Payer: Beech Street Commercial |
$3,276.55
|
| Rate for Payer: Cash Price |
$2,414.30
|
| Rate for Payer: Cash Price |
$2,414.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,345.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,380.02
|
| Rate for Payer: First Choice Health Commercial |
$3,104.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,276.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.64
|
| Rate for Payer: HealthUtah PPO |
$3,449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,345.53
|
| Rate for Payer: Multiplan Medicare/VA |
$467.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,380.02
|
| Rate for Payer: PacificSource Commercial |
$3,104.10
|
| Rate for Payer: PHCS PPO |
$3,276.55
|
| Rate for Payer: Three Rivers PPO |
$2,586.75
|
| Rate for Payer: TriWest Veterans Administration |
$549.64
|
| Rate for Payer: United Healthcare Commercial |
$3,000.63
|
| Rate for Payer: United Healthcare Medicare |
$549.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,931.65
|
|
|
HC PRO ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$3,113.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
9821404001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$513.17 |
| Max. Negotiated Rate |
$3,113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,050.74
|
| Rate for Payer: Aetna of WY Medicare |
$603.73
|
| Rate for Payer: Beech Street Commercial |
$2,957.35
|
| Rate for Payer: Cash Price |
$2,179.10
|
| Rate for Payer: Cash Price |
$2,179.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,019.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,050.74
|
| Rate for Payer: First Choice Health Commercial |
$2,801.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,957.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.73
|
| Rate for Payer: HealthUtah PPO |
$3,113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,019.61
|
| Rate for Payer: Multiplan Medicare/VA |
$513.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,050.74
|
| Rate for Payer: PacificSource Commercial |
$2,801.70
|
| Rate for Payer: PHCS PPO |
$2,957.35
|
| Rate for Payer: Three Rivers PPO |
$2,334.75
|
| Rate for Payer: TriWest Veterans Administration |
$603.73
|
| Rate for Payer: United Healthcare Commercial |
$2,708.31
|
| Rate for Payer: United Healthcare Medicare |
$603.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2,646.05
|
|
|
HC PRO ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS S2083
|
| Hospital Charge Code |
983S208301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.72
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Beech Street Commercial |
$155.80
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.08
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Cigna of WY Commercial |
$160.72
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: First Choice Health Commercial |
$147.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: HealthUtah PPO |
$164.00
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: One Health Plan of WY PPO |
$160.72
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$147.60
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$155.80
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$123.00
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Commercial |
$142.68
|
| Rate for Payer: WINHealth Partners Commercial |
$155.80
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
|
|
HC PRO ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS S2083
|
| Hospital Charge Code |
981S208301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.26
|
| Rate for Payer: Beech Street Commercial |
$177.65
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.39
|
| Rate for Payer: Cigna of WY Commercial |
$183.26
|
| Rate for Payer: First Choice Health Commercial |
$168.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.65
|
| Rate for Payer: HealthUtah PPO |
$187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.39
|
| Rate for Payer: One Health Plan of WY PPO |
$183.26
|
| Rate for Payer: PacificSource Commercial |
$168.30
|
| Rate for Payer: PHCS PPO |
$177.65
|
| Rate for Payer: Three Rivers PPO |
$140.25
|
| Rate for Payer: United Healthcare Commercial |
$162.69
|
| Rate for Payer: WINHealth Partners Commercial |
$177.65
|
|
