|
HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
3058566001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
5101313101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.68
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$135.55
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.68
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$142.68
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
5101313101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.36
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$154.24
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$162.36
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$162.36
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
7611313101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Aetna of WY Medicare |
$331.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.74
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$277.15
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.74
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$291.74
|
| Rate for Payer: WINHealth Partners Commercial |
$492.94
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
7611313101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.98
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$315.38
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.98
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$331.98
|
| Rate for Payer: WINHealth Partners Commercial |
$477.85
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
7611313201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.44
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$340.52
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$358.44
|
| Rate for Payer: WINHealth Partners Commercial |
$605.64
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
7611313201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.88
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$387.49
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.88
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$407.88
|
| Rate for Payer: WINHealth Partners Commercial |
$587.10
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECMPL WND LID,NOS,EAR 1.1-2.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
7611315101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Aetna of WY Medicare |
$331.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.74
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$277.15
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.74
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$291.74
|
| Rate for Payer: WINHealth Partners Commercial |
$492.94
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC RECMPL WND LID,NOS,EAR 1.1-2.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
7611315101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.98
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$315.38
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.98
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$331.98
|
| Rate for Payer: WINHealth Partners Commercial |
$477.85
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
7611315201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.44
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$340.52
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$358.44
|
| Rate for Payer: WINHealth Partners Commercial |
$605.64
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
7611315201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.88
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$387.49
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.88
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$407.88
|
| Rate for Payer: WINHealth Partners Commercial |
$587.10
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
7611312101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.44
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$340.52
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$358.44
|
| Rate for Payer: WINHealth Partners Commercial |
$605.64
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
7611312101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.88
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$387.49
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.88
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$407.88
|
| Rate for Payer: WINHealth Partners Commercial |
$587.10
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC RECONSTRUC OF NAIL BED
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
7611176001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC RECONSTRUC OF NAIL BED
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
7611176001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC RECONSTRUCTION NAIL BED W/GRAFT
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
5101176201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.24 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$126.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.78
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$105.24
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$110.78
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$110.78
|
| Rate for Payer: WINHealth Partners Commercial |
$187.18
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC RECONSTRUCTION NAIL BED W/GRAFT
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 11762
|
| Hospital Charge Code |
5101176201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.06
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$119.76
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.06
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$126.06
|
| Rate for Payer: WINHealth Partners Commercial |
$181.45
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC RECOVERY ROOM TIME - EACH ADD 1 MINUTE
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
7100000002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Aetna of WY Medicare |
$13.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.20
|
| Rate for Payer: Altius Commercial |
$19.20
|
| Rate for Payer: Beech Street Commercial |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: Entrust Commercial |
$19.00
|
| Rate for Payer: First Choice Health Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.60
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WINHealth Partners Commercial |
$19.60
|
| Rate for Payer: Wise Provider Network Commercial |
$19.00
|
|
|
HC RECOVERY ROOM TIME - EACH ADD 1 MINUTE
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
7100000002
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.20
|
| Rate for Payer: Altius Commercial |
$19.20
|
| Rate for Payer: Beech Street Commercial |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: Entrust Commercial |
$19.00
|
| Rate for Payer: First Choice Health Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.20
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$12.54
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.60
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.20
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
| Rate for Payer: Wise Provider Network Commercial |
$19.00
|
|
|
HC RECOVERY ROOM TIME - INITIAL BASE CHARGE
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
7100000001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$289.28 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$289.28
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$304.50
|
| Rate for Payer: WINHealth Partners Commercial |
$514.50
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
HC RECOVERY ROOM TIME - INITIAL BASE CHARGE
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
7100000001
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$329.18 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.50
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$329.18
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$346.50
|
| Rate for Payer: United Healthcare Commercial |
$456.75
|
| Rate for Payer: United Healthcare Medicare |
$346.50
|
| Rate for Payer: WINHealth Partners Commercial |
$498.75
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
HC REDUCE TEMPOROMANDIBL DISLOC
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
7612148001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC REDUCE TEMPOROMANDIBL DISLOC
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
7612148001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC REFILL/MAINT, PORTABLE PUMP
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 96521
|
| Hospital Charge Code |
3309652101
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$592.52 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$907.20
|
| Rate for Payer: Altius Commercial |
$907.20
|
| Rate for Payer: Beech Street Commercial |
$926.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$775.84
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: Entrust Commercial |
$897.75
|
| Rate for Payer: First Choice Health Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$623.70
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$592.52
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$926.10
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$623.70
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
| Rate for Payer: WINHealth Partners Commercial |
$897.75
|
| Rate for Payer: Wise Provider Network Commercial |
$897.75
|
|
|
HC REFILL/MAINT, PORTABLE PUMP
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 96521
|
| Hospital Charge Code |
3309652101
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$520.70 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Aetna of WY Medicare |
$623.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$907.20
|
| Rate for Payer: Altius Commercial |
$907.20
|
| Rate for Payer: Beech Street Commercial |
$926.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$775.84
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: Entrust Commercial |
$897.75
|
| Rate for Payer: First Choice Health Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$548.10
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$520.70
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$926.10
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$548.10
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$548.10
|
| Rate for Payer: WINHealth Partners Commercial |
$926.10
|
| Rate for Payer: Wise Provider Network Commercial |
$897.75
|
|
