|
HC RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
5104125001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| 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 |
$130.02
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.52
|
| 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 |
$130.02
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$130.02
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC RT BIPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$672.22 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Aetna of WY Medicare |
$805.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,171.20
|
| Rate for Payer: Altius Commercial |
$1,171.20
|
| Rate for Payer: Beech Street Commercial |
$1,195.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,001.62
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: Entrust Commercial |
$1,159.00
|
| Rate for Payer: First Choice Health Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.60
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$672.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,195.60
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.60
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$707.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,195.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,159.00
|
|
|
HC RT BIPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$764.94 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,171.20
|
| Rate for Payer: Altius Commercial |
$1,171.20
|
| Rate for Payer: Beech Street Commercial |
$1,195.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,001.62
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: Entrust Commercial |
$1,159.00
|
| Rate for Payer: First Choice Health Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$805.20
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$764.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,195.60
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$805.20
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$805.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,159.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,159.00
|
|
|
HC RT BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4027372302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC RT BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4027372302
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC RT BRONCHIAL ALLERGY TESTS,DRUGS
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
4109507001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$584.06 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,038.80
|
| Rate for Payer: Aetna of WY Medicare |
$699.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,017.60
|
| Rate for Payer: Altius Commercial |
$1,017.60
|
| Rate for Payer: Beech Street Commercial |
$1,038.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$870.26
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,028.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,038.80
|
| Rate for Payer: Entrust Commercial |
$1,007.00
|
| Rate for Payer: First Choice Health Commercial |
$1,007.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,007.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$614.80
|
| Rate for Payer: HealthUtah PPO |
$1,060.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,028.20
|
| Rate for Payer: Multiplan Medicare/VA |
$584.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,038.80
|
| Rate for Payer: PacificSource Commercial |
$954.00
|
| Rate for Payer: PHCS PPO |
$1,038.80
|
| Rate for Payer: Three Rivers PPO |
$795.00
|
| Rate for Payer: TriWest Veterans Administration |
$614.80
|
| Rate for Payer: United Healthcare Commercial |
$922.20
|
| Rate for Payer: United Healthcare Medicare |
$614.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,038.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,007.00
|
|
|
HC RT BRONCHIAL ALLERGY TESTS,DRUGS
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
4109507001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$664.62 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,038.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,017.60
|
| Rate for Payer: Altius Commercial |
$1,017.60
|
| Rate for Payer: Beech Street Commercial |
$1,038.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$870.26
|
| Rate for Payer: Cash Price |
$742.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,028.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,038.80
|
| Rate for Payer: Entrust Commercial |
$1,007.00
|
| Rate for Payer: First Choice Health Commercial |
$1,007.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,007.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.60
|
| Rate for Payer: HealthUtah PPO |
$1,060.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,028.20
|
| Rate for Payer: Multiplan Medicare/VA |
$664.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,038.80
|
| Rate for Payer: PacificSource Commercial |
$954.00
|
| Rate for Payer: PHCS PPO |
$1,038.80
|
| Rate for Payer: Three Rivers PPO |
$795.00
|
| Rate for Payer: TriWest Veterans Administration |
$699.60
|
| Rate for Payer: United Healthcare Commercial |
$922.20
|
| Rate for Payer: United Healthcare Medicare |
$699.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,007.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,007.00
|
|
|
HC RT CHEST WALL MANIPULATION, INITIAL
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
4109466701
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC RT CHEST WALL MANIPULATION, INITIAL
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
4109466701
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC RT CHEST WALL MANIPULATION,SUBSEQUENT
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
4109466801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$321.60
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.04
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.10
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$210.04
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$221.10
|
| Rate for Payer: United Healthcare Commercial |
$291.45
|
| Rate for Payer: United Healthcare Medicare |
$221.10
|
| Rate for Payer: WINHealth Partners Commercial |
$318.25
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
HC RT CHEST WALL MANIPULATION,SUBSEQUENT
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
4109466801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$184.58 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$221.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$321.60
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.04
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.30
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$184.58
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.30
|
| Rate for Payer: United Healthcare Commercial |
$291.45
|
| Rate for Payer: United Healthcare Medicare |
$194.30
|
| Rate for Payer: WINHealth Partners Commercial |
$328.30
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
HC RT CONTINUOUS INHALATION TX, 1ST HR
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC RT CONTINUOUS INHALATION TX, 1ST HR
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC RT CONTINUOUS INHALATION TX, EACH ADD HR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC RT CONTINUOUS INHALATION TX, EACH ADD HR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC RT CPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$672.22 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Aetna of WY Medicare |
$805.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,171.20
|
| Rate for Payer: Altius Commercial |
$1,171.20
|
| Rate for Payer: Beech Street Commercial |
$1,195.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,001.62
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: Entrust Commercial |
$1,159.00
|
| Rate for Payer: First Choice Health Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.60
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$672.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,195.60
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.60
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$707.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,195.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,159.00
|
|
|
HC RT CPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$764.94 |
| Max. Negotiated Rate |
$1,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,195.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,171.20
|
| Rate for Payer: Altius Commercial |
$1,171.20
|
| Rate for Payer: Beech Street Commercial |
$1,195.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,001.62
|
| Rate for Payer: Cash Price |
$854.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,183.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,195.60
|
| Rate for Payer: Entrust Commercial |
$1,159.00
|
| Rate for Payer: First Choice Health Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,159.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$805.20
|
| Rate for Payer: HealthUtah PPO |
$1,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,183.40
|
| Rate for Payer: Multiplan Medicare/VA |
$764.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,195.60
|
| Rate for Payer: PacificSource Commercial |
$1,098.00
|
| Rate for Payer: PHCS PPO |
$1,195.60
|
| Rate for Payer: Three Rivers PPO |
$915.00
|
| Rate for Payer: TriWest Veterans Administration |
$805.20
|
| Rate for Payer: United Healthcare Commercial |
$1,061.40
|
| Rate for Payer: United Healthcare Medicare |
$805.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,159.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,159.00
|
|
|
HC RT DEMO &/OR EVAL,PT USE,AEROSOL DEVICE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4109466401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC RT DEMO &/OR EVAL,PT USE,AEROSOL DEVICE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4109466401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC RT HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4109295001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$608.86 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Aetna of WY Medicare |
$729.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.90
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$608.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$640.90
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$640.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,082.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC RT HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4109295001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$692.84 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$729.30
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$692.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$729.30
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$729.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC RT INHALATION TREATMENT
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| 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 RT INHALATION TREATMENT
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| 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 RT MDI/DPI
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464002
|
|
Hospital Revenue Code
|
410
|
| 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 RT MDI/DPI
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464002
|
|
Hospital Revenue Code
|
410
|
| 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
|
|
