|
HC PT VASOPNEUMATIC DEVICE THERAPY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
4209701601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC PT VASOPNEUMATIC DEVICE THERAPY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
4209701601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC PT WHIRLPOOL THERAPY
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC PT WHIRLPOOL THERAPY
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC PT WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
4209760201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC PT WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
4209760201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC PUCT/ASPIR BREAST CYST,EACH ADDN
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
3611900101
|
|
Hospital Revenue Code
|
361
|
| 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 PUCT/ASPIR BREAST CYST,EACH ADDN
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 19001
|
| Hospital Charge Code |
3611900101
|
|
Hospital Revenue Code
|
361
|
| 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 PULM FUNCTION TEST BY GAS - HELIUM DILUTION LUNG VOLUMES
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC PULM FUNCTION TEST BY GAS - HELIUM DILUTION LUNG VOLUMES
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP - BODY PLETHYSMOGRAPHIC LUNG VOLUMES
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
4609472602
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$253.94 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$396.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$388.80
|
| Rate for Payer: Altius Commercial |
$388.80
|
| Rate for Payer: Beech Street Commercial |
$396.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$392.85
|
| Rate for Payer: Cigna of WY Commercial |
$396.90
|
| Rate for Payer: Entrust Commercial |
$384.75
|
| Rate for Payer: First Choice Health Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.30
|
| Rate for Payer: HealthUtah PPO |
$405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$392.85
|
| Rate for Payer: Multiplan Medicare/VA |
$253.94
|
| Rate for Payer: One Health Plan of WY PPO |
$396.90
|
| Rate for Payer: PacificSource Commercial |
$364.50
|
| Rate for Payer: PHCS PPO |
$396.90
|
| Rate for Payer: Three Rivers PPO |
$303.75
|
| Rate for Payer: TriWest Veterans Administration |
$267.30
|
| Rate for Payer: United Healthcare Commercial |
$352.35
|
| Rate for Payer: United Healthcare Medicare |
$267.30
|
| Rate for Payer: WINHealth Partners Commercial |
$384.75
|
| Rate for Payer: Wise Provider Network Commercial |
$384.75
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP - BODY PLETHYSMOGRAPHIC LUNG VOLUMES
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
4609472602
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$223.16 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$396.90
|
| Rate for Payer: Aetna of WY Medicare |
$267.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$388.80
|
| Rate for Payer: Altius Commercial |
$388.80
|
| Rate for Payer: Beech Street Commercial |
$396.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$392.85
|
| Rate for Payer: Cigna of WY Commercial |
$396.90
|
| Rate for Payer: Entrust Commercial |
$384.75
|
| Rate for Payer: First Choice Health Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.90
|
| Rate for Payer: HealthUtah PPO |
$405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$392.85
|
| Rate for Payer: Multiplan Medicare/VA |
$223.16
|
| Rate for Payer: One Health Plan of WY PPO |
$396.90
|
| Rate for Payer: PacificSource Commercial |
$364.50
|
| Rate for Payer: PHCS PPO |
$396.90
|
| Rate for Payer: Three Rivers PPO |
$303.75
|
| Rate for Payer: TriWest Veterans Administration |
$234.90
|
| Rate for Payer: United Healthcare Commercial |
$352.35
|
| Rate for Payer: United Healthcare Medicare |
$234.90
|
| Rate for Payer: WINHealth Partners Commercial |
$396.90
|
| Rate for Payer: Wise Provider Network Commercial |
$384.75
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP - PLETHYSMOGRAPHY
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
4609472601
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Medicare |
$376.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.60
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$314.07
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$330.60
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$330.60
|
| Rate for Payer: WINHealth Partners Commercial |
$558.60
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP - PLETHYSMOGRAPHY
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
4609472601
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.20
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$357.39
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$376.20
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$376.20
|
| Rate for Payer: WINHealth Partners Commercial |
$541.50
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC PULMONARY STRESS TESTING
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
4609461801
|
|
Hospital Revenue Code
|
460
|
| 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 PULMONARY STRESS TESTING
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
4609461801
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$228.66 |
| 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: 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: 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 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
5101110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
5101110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
5101110401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.42
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$27.00
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.42
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$28.42
|
| Rate for Payer: WINHealth Partners Commercial |
$48.02
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC PUNCH BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
5101110401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.34
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$30.72
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.34
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$32.34
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
7611016001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$366.42
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$385.70
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$385.70
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
7611016001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
5101016001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
5101016001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC PUNCTURE ASPIRATION CYST BREAST
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
5101900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$29.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.10
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$24.80
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
| Rate for Payer: WINHealth Partners Commercial |
$44.10
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
