|
HC RIA NONANTIBODY - VOLTAGE GATED CA
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - VOLTAGE GATED CA
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - VOLTAGE GATED POTASSIUM CHANNEL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - VOLTAGE GATED POTASSIUM CHANNEL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351912
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
3028675701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
3028675701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
3028675702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
3028675702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
5109760201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.12
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.64
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.26
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.26
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$56.26
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
5109760201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.12
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.64
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.02
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$60.82
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.02
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$64.02
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
5104080501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$142.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$207.36
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.34
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.28
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$119.02
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$125.28
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicare |
$125.28
|
| Rate for Payer: WINHealth Partners Commercial |
$211.68
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
5104080501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$207.36
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.34
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.56
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$135.43
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$142.56
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicare |
$142.56
|
| Rate for Payer: WINHealth Partners Commercial |
$205.20
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC RMVL FB INTRAOCULAR
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
7616523501
|
|
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 RMVL FB INTRAOCULAR
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
7616523501
|
|
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 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
5102052501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.95 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$248.92
|
| Rate for Payer: Aetna of WY Medicare |
$167.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$243.84
|
| Rate for Payer: Altius Commercial |
$243.84
|
| Rate for Payer: Beech Street Commercial |
$248.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$208.53
|
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$246.38
|
| Rate for Payer: Cigna of WY Commercial |
$248.92
|
| Rate for Payer: Entrust Commercial |
$241.30
|
| Rate for Payer: First Choice Health Commercial |
$241.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$241.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.32
|
| Rate for Payer: HealthUtah PPO |
$254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$246.38
|
| Rate for Payer: Multiplan Medicare/VA |
$139.95
|
| Rate for Payer: One Health Plan of WY PPO |
$248.92
|
| Rate for Payer: PacificSource Commercial |
$228.60
|
| Rate for Payer: PHCS PPO |
$248.92
|
| Rate for Payer: Three Rivers PPO |
$190.50
|
| Rate for Payer: TriWest Veterans Administration |
$147.32
|
| Rate for Payer: United Healthcare Commercial |
$220.98
|
| Rate for Payer: United Healthcare Medicare |
$147.32
|
| Rate for Payer: WINHealth Partners Commercial |
$248.92
|
| Rate for Payer: Wise Provider Network Commercial |
$241.30
|
|
|
HC RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
5102052501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.26 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$248.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$243.84
|
| Rate for Payer: Altius Commercial |
$243.84
|
| Rate for Payer: Beech Street Commercial |
$248.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$208.53
|
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$246.38
|
| Rate for Payer: Cigna of WY Commercial |
$248.92
|
| Rate for Payer: Entrust Commercial |
$241.30
|
| Rate for Payer: First Choice Health Commercial |
$241.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$241.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.64
|
| Rate for Payer: HealthUtah PPO |
$254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$246.38
|
| Rate for Payer: Multiplan Medicare/VA |
$159.26
|
| Rate for Payer: One Health Plan of WY PPO |
$248.92
|
| Rate for Payer: PacificSource Commercial |
$228.60
|
| Rate for Payer: PHCS PPO |
$248.92
|
| Rate for Payer: Three Rivers PPO |
$190.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.64
|
| Rate for Payer: United Healthcare Commercial |
$220.98
|
| Rate for Payer: United Healthcare Medicare |
$167.64
|
| Rate for Payer: WINHealth Partners Commercial |
$241.30
|
| Rate for Payer: Wise Provider Network Commercial |
$241.30
|
|
|
HC RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
5103255201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.81 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$107.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.48
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.82
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.54
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$89.81
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$94.54
|
| Rate for Payer: United Healthcare Commercial |
$141.81
|
| Rate for Payer: United Healthcare Medicare |
$94.54
|
| Rate for Payer: WINHealth Partners Commercial |
$159.74
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
5103255201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.48
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.82
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.58
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$102.20
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$107.58
|
| Rate for Payer: United Healthcare Commercial |
$141.81
|
| Rate for Payer: United Healthcare Medicare |
$107.58
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
5101100801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Aetna of WY Medicare |
$182.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.96
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.08
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$152.08
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$160.08
|
| Rate for Payer: United Healthcare Commercial |
$240.12
|
| Rate for Payer: United Healthcare Medicare |
$160.08
|
| Rate for Payer: WINHealth Partners Commercial |
$270.48
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
5101100801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.05 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.96
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.16
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$173.05
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.16
|
| Rate for Payer: United Healthcare Commercial |
$240.12
|
| Rate for Payer: United Healthcare Medicare |
$182.16
|
| Rate for Payer: WINHealth Partners Commercial |
$262.20
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
5101120101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
5101120101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC ROTAVIRUS - ROTAVIRUS ANTIBODY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86759
|
| Hospital Charge Code |
3028675901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| 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: 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: 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 ROTAVIRUS - ROTAVIRUS ANTIBODY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86759
|
| Hospital Charge Code |
3028675901
|
|
Hospital Revenue Code
|
302
|
| 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 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
5104125001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.26
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$108.55
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$114.26
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
