|
HC PSA SCREENING
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
301G010301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
9009079101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$260.20 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$398.40
|
| Rate for Payer: Altius Commercial |
$398.40
|
| Rate for Payer: Beech Street Commercial |
$406.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$340.72
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: Entrust Commercial |
$394.25
|
| Rate for Payer: First Choice Health Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$273.90
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Multiplan Medicare/VA |
$260.20
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$406.70
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: TriWest Veterans Administration |
$273.90
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$273.90
|
| Rate for Payer: WINHealth Partners Commercial |
$394.25
|
| Rate for Payer: Wise Provider Network Commercial |
$394.25
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
9009079101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$159.46 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Aetna of WY Medicare |
$273.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$398.40
|
| Rate for Payer: Altius Commercial |
$398.40
|
| Rate for Payer: Beech Street Commercial |
$406.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$340.72
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: Entrust Commercial |
$394.25
|
| Rate for Payer: First Choice Health Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.70
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Multiplan Medicare/VA |
$228.66
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: Optum Behavioral Health Commercial |
$159.46
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$406.70
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: TriWest Veterans Administration |
$240.70
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$240.70
|
| Rate for Payer: WINHealth Partners Commercial |
$406.70
|
| Rate for Payer: Wise Provider Network Commercial |
$394.25
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
9009084001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$63.86 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.10
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$107.44
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: Optum Behavioral Health Commercial |
$63.86
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$113.10
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
9009084001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.70
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$128.70
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC PSYCHOTHERAPY FOR CRISIS INIT 60 MINS
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
9149083901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC PSYCHOTHERAPY FOR CRISIS INIT 60 MINS
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
9149083901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$128.51 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: Optum Behavioral Health Commercial |
$128.51
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
9149083201
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
9149083201
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: Optum Behavioral Health Commercial |
$69.31
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
9149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$240.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$201.12
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: Optum Behavioral Health Commercial |
$91.51
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.70
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$211.70
|
| Rate for Payer: WINHealth Partners Commercial |
$357.70
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
9149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.90
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$228.86
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.90
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$240.90
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
9149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
9149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$134.44 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: Optum Behavioral Health Commercial |
$134.44
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
9009083301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$166.16 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.90
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$166.16
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$174.90
|
| Rate for Payer: WINHealth Partners Commercial |
$251.75
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
9009083301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Aetna of WY Medicare |
$174.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.70
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$146.02
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$153.70
|
| Rate for Payer: WINHealth Partners Commercial |
$259.70
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC PT AQUATIC THERAPY/EXERCISES
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
4209711301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC PT AQUATIC THERAPY/EXERCISES
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
4209711301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC PT CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC PT CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| 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 |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| 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 |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC PT DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
4209759701
|
|
Hospital Revenue Code
|
420
|
| 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 PT DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
4209759701
|
|
Hospital Revenue Code
|
420
|
| 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 PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC PT ELEC STIM OTHER THAN WOUND
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
420G028301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC PT ELEC STIM OTHER THAN WOUND
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
420G028301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
