|
HC SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5101201401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Aetna of WY Medicare |
$50.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.08
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$41.88
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.08
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$44.08
|
| Rate for Payer: WINHealth Partners Commercial |
$74.48
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
5101201501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.68
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$52.90
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$55.68
|
| Rate for Payer: WINHealth Partners Commercial |
$94.08
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
5101201501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.36
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$60.19
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$63.36
|
| Rate for Payer: WINHealth Partners Commercial |
$91.20
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
5101200701
|
|
Hospital Revenue Code
|
510
|
| 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 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
5101200701
|
|
Hospital Revenue Code
|
510
|
| 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 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
5101200401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$60.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.32
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.53
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.36
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$50.69
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.36
|
| Rate for Payer: United Healthcare Commercial |
$80.04
|
| Rate for Payer: United Healthcare Medicare |
$53.36
|
| Rate for Payer: WINHealth Partners Commercial |
$90.16
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
5101200401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.32
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.53
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.72
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$57.68
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$60.72
|
| Rate for Payer: United Healthcare Commercial |
$80.04
|
| Rate for Payer: United Healthcare Medicare |
$60.72
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC SINUS ENDOSCOPY
|
Facility
|
OP
|
$5,230.00
|
|
| Hospital Charge Code |
3600000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,881.73 |
| Max. Negotiated Rate |
$5,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,125.40
|
| Rate for Payer: Aetna of WY Medicare |
$3,451.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,020.80
|
| Rate for Payer: Altius Commercial |
$5,020.80
|
| Rate for Payer: Beech Street Commercial |
$5,125.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,293.83
|
| Rate for Payer: Cash Price |
$3,661.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,073.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,125.40
|
| Rate for Payer: Entrust Commercial |
$4,968.50
|
| Rate for Payer: First Choice Health Commercial |
$4,968.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,968.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,033.40
|
| Rate for Payer: HealthUtah PPO |
$5,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,073.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,881.73
|
| Rate for Payer: One Health Plan of WY PPO |
$5,125.40
|
| Rate for Payer: PacificSource Commercial |
$4,707.00
|
| Rate for Payer: PHCS PPO |
$5,125.40
|
| Rate for Payer: Three Rivers PPO |
$3,922.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,033.40
|
| Rate for Payer: United Healthcare Commercial |
$4,550.10
|
| Rate for Payer: United Healthcare Medicare |
$3,033.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,125.40
|
| Rate for Payer: Wise Provider Network Commercial |
$4,968.50
|
|
|
HC SINUS ENDOSCOPY
|
Facility
|
IP
|
$5,230.00
|
|
| Hospital Charge Code |
3600000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,279.21 |
| Max. Negotiated Rate |
$5,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,020.80
|
| Rate for Payer: Altius Commercial |
$5,020.80
|
| Rate for Payer: Beech Street Commercial |
$5,125.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,293.83
|
| Rate for Payer: Cash Price |
$3,661.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,073.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,125.40
|
| Rate for Payer: Entrust Commercial |
$4,968.50
|
| Rate for Payer: First Choice Health Commercial |
$4,968.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,968.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,451.80
|
| Rate for Payer: HealthUtah PPO |
$5,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,073.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3,279.21
|
| Rate for Payer: One Health Plan of WY PPO |
$5,125.40
|
| Rate for Payer: PacificSource Commercial |
$4,707.00
|
| Rate for Payer: PHCS PPO |
$5,125.40
|
| Rate for Payer: Three Rivers PPO |
$3,922.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,451.80
|
| Rate for Payer: United Healthcare Commercial |
$4,550.10
|
| Rate for Payer: United Healthcare Medicare |
$3,451.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,968.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,968.50
|
|
|
HC SKIN TEST TUBERCULOSIS INTRADERMAL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
3028658001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC SKIN TEST TUBERCULOSIS INTRADERMAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
3028658001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC SKIN TISSUE PROCEDURE UNLISTED
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
7611799901
|
|
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 SKIN TISSUE PROCEDURE UNLISTED
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
7611799901
|
|
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 SKYLA, 13.5 MG
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
HCPCS J7301
|
| Hospital Charge Code |
636J730101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$978.12 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,528.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,497.60
|
| Rate for Payer: Altius Commercial |
$1,497.60
|
| Rate for Payer: Beech Street Commercial |
$1,528.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,280.76
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,513.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,528.80
|
| Rate for Payer: Entrust Commercial |
$1,482.00
|
| Rate for Payer: First Choice Health Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,029.60
|
| Rate for Payer: HealthUtah PPO |
$1,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,513.20
|
| Rate for Payer: Multiplan Medicare/VA |
$978.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,528.80
|
| Rate for Payer: PacificSource Commercial |
$1,404.00
|
| Rate for Payer: PHCS PPO |
$1,528.80
|
| Rate for Payer: Three Rivers PPO |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,029.60
|
| Rate for Payer: United Healthcare Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare Medicare |
$1,029.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,482.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,482.00
|
|
|
HC SKYLA, 13.5 MG
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
HCPCS J7301
|
| Hospital Charge Code |
636J730101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$859.56 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,528.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,029.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,497.60
|
| Rate for Payer: Altius Commercial |
$1,497.60
|
| Rate for Payer: Beech Street Commercial |
$1,528.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,280.76
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,513.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,528.80
|
| Rate for Payer: Entrust Commercial |
$1,482.00
|
| Rate for Payer: First Choice Health Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$904.80
|
| Rate for Payer: HealthUtah PPO |
$1,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,513.20
|
| Rate for Payer: Multiplan Medicare/VA |
$859.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,528.80
|
| Rate for Payer: PacificSource Commercial |
$1,404.00
|
| Rate for Payer: PHCS PPO |
$1,528.80
|
| Rate for Payer: Three Rivers PPO |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration |
$904.80
|
| Rate for Payer: United Healthcare Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare Medicare |
$904.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,528.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,482.00
|
|
|
HC SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
7409580601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$333.36 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.90
|
| Rate for Payer: Aetna of WY Medicare |
$399.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$580.80
|
| Rate for Payer: Altius Commercial |
$580.80
|
| Rate for Payer: Beech Street Commercial |
$592.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$496.70
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.85
|
| Rate for Payer: Cigna of WY Commercial |
$592.90
|
| Rate for Payer: Entrust Commercial |
$574.75
|
| Rate for Payer: First Choice Health Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.90
|
| Rate for Payer: HealthUtah PPO |
$605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.85
|
| Rate for Payer: Multiplan Medicare/VA |
$333.36
|
| Rate for Payer: One Health Plan of WY PPO |
$592.90
|
| Rate for Payer: PacificSource Commercial |
$544.50
|
| Rate for Payer: PHCS PPO |
$592.90
|
| Rate for Payer: Three Rivers PPO |
$453.75
|
| Rate for Payer: TriWest Veterans Administration |
$350.90
|
| Rate for Payer: United Healthcare Commercial |
$526.35
|
| Rate for Payer: United Healthcare Medicare |
$350.90
|
| Rate for Payer: WINHealth Partners Commercial |
$592.90
|
| Rate for Payer: Wise Provider Network Commercial |
$574.75
|
|
|
HC SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
7409580601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$379.34 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$580.80
|
| Rate for Payer: Altius Commercial |
$580.80
|
| Rate for Payer: Beech Street Commercial |
$592.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$496.70
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.85
|
| Rate for Payer: Cigna of WY Commercial |
$592.90
|
| Rate for Payer: Entrust Commercial |
$574.75
|
| Rate for Payer: First Choice Health Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.30
|
| Rate for Payer: HealthUtah PPO |
$605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.85
|
| Rate for Payer: Multiplan Medicare/VA |
$379.34
|
| Rate for Payer: One Health Plan of WY PPO |
$592.90
|
| Rate for Payer: PacificSource Commercial |
$544.50
|
| Rate for Payer: PHCS PPO |
$592.90
|
| Rate for Payer: Three Rivers PPO |
$453.75
|
| Rate for Payer: TriWest Veterans Administration |
$399.30
|
| Rate for Payer: United Healthcare Commercial |
$526.35
|
| Rate for Payer: United Healthcare Medicare |
$399.30
|
| Rate for Payer: WINHealth Partners Commercial |
$574.75
|
| Rate for Payer: Wise Provider Network Commercial |
$574.75
|
|
|
HC SLP ASSESSMENT OF APHASIA
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4409610501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC SLP ASSESSMENT OF APHASIA
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4409610501
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$435.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$633.60
|
| Rate for Payer: Altius Commercial |
$633.60
|
| Rate for Payer: Beech Street Commercial |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.86
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: Entrust Commercial |
$627.00
|
| Rate for Payer: First Choice Health Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$646.80
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.80
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$413.82 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$633.60
|
| Rate for Payer: Altius Commercial |
$633.60
|
| Rate for Payer: Beech Street Commercial |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.86
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: Entrust Commercial |
$627.00
|
| Rate for Payer: First Choice Health Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.60
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$413.82
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$646.80
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$435.60
|
| Rate for Payer: WINHealth Partners Commercial |
$627.00
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC SLP COGNITIVE FUNCT THER INTERV, EA ADDL 15 MIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4409713001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC SLP COGNITIVE FUNCT THER INTERV, EA ADDL 15 MIN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4409713001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
4449261001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
4449261001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
