|
HC SLP THER SRVC, SPEECH GEN DEV USE, W/PROG
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
4409260901
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC SLP TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
4409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$190.10 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.10
|
| Rate for Payer: Aetna of WY Medicare |
$227.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$331.20
|
| Rate for Payer: Altius Commercial |
$331.20
|
| Rate for Payer: Beech Street Commercial |
$338.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$334.65
|
| Rate for Payer: Cigna of WY Commercial |
$338.10
|
| Rate for Payer: Entrust Commercial |
$327.75
|
| Rate for Payer: First Choice Health Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.10
|
| Rate for Payer: HealthUtah PPO |
$345.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$334.65
|
| Rate for Payer: Multiplan Medicare/VA |
$190.10
|
| Rate for Payer: One Health Plan of WY PPO |
$338.10
|
| Rate for Payer: PacificSource Commercial |
$310.50
|
| Rate for Payer: PHCS PPO |
$338.10
|
| Rate for Payer: Three Rivers PPO |
$258.75
|
| Rate for Payer: TriWest Veterans Administration |
$200.10
|
| Rate for Payer: United Healthcare Commercial |
$300.15
|
| Rate for Payer: United Healthcare Medicare |
$200.10
|
| Rate for Payer: WINHealth Partners Commercial |
$338.10
|
| Rate for Payer: Wise Provider Network Commercial |
$327.75
|
|
|
HC SLP TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
4409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$331.20
|
| Rate for Payer: Altius Commercial |
$331.20
|
| Rate for Payer: Beech Street Commercial |
$338.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$334.65
|
| Rate for Payer: Cigna of WY Commercial |
$338.10
|
| Rate for Payer: Entrust Commercial |
$327.75
|
| Rate for Payer: First Choice Health Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.70
|
| Rate for Payer: HealthUtah PPO |
$345.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$334.65
|
| Rate for Payer: Multiplan Medicare/VA |
$216.32
|
| Rate for Payer: One Health Plan of WY PPO |
$338.10
|
| Rate for Payer: PacificSource Commercial |
$310.50
|
| Rate for Payer: PHCS PPO |
$338.10
|
| Rate for Payer: Three Rivers PPO |
$258.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.70
|
| Rate for Payer: United Healthcare Commercial |
$300.15
|
| Rate for Payer: United Healthcare Medicare |
$227.70
|
| Rate for Payer: WINHealth Partners Commercial |
$327.75
|
| Rate for Payer: Wise Provider Network Commercial |
$327.75
|
|
|
HC SMEAR COMPLEX STAIN OVA PARASITES
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| 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 SMEAR COMPLEX STAIN OVA PARASITES
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| 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 SMEAR,FLUOR STAIN,INTERP - AFB STAIN
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3068720601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3068720601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC SMEAR GRAM STAIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC SMEAR GRAM STAIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - FECAL WBC
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - FECAL WBC
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - WET PREP GENITAL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - WET PREP GENITAL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
5101200501
|
|
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 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
5101200501
|
|
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 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
5101200601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.69 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.18
|
| Rate for Payer: Aetna of WY Medicare |
$93.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.36
|
| Rate for Payer: Altius Commercial |
$135.36
|
| Rate for Payer: Beech Street Commercial |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.77
|
| Rate for Payer: Cigna of WY Commercial |
$138.18
|
| Rate for Payer: Entrust Commercial |
$133.95
|
| Rate for Payer: First Choice Health Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.78
|
| Rate for Payer: HealthUtah PPO |
$141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.77
|
| Rate for Payer: Multiplan Medicare/VA |
$77.69
|
| Rate for Payer: One Health Plan of WY PPO |
$138.18
|
| Rate for Payer: PacificSource Commercial |
$126.90
|
| Rate for Payer: PHCS PPO |
$138.18
|
| Rate for Payer: Three Rivers PPO |
$105.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.78
|
| Rate for Payer: United Healthcare Commercial |
$122.67
|
| Rate for Payer: United Healthcare Medicare |
$81.78
|
| Rate for Payer: WINHealth Partners Commercial |
$138.18
|
| Rate for Payer: Wise Provider Network Commercial |
$133.95
|
|
|
HC SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
5101200601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.36
|
| Rate for Payer: Altius Commercial |
$135.36
|
| Rate for Payer: Beech Street Commercial |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.77
|
| Rate for Payer: Cigna of WY Commercial |
$138.18
|
| Rate for Payer: Entrust Commercial |
$133.95
|
| Rate for Payer: First Choice Health Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.06
|
| Rate for Payer: HealthUtah PPO |
$141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.77
|
| Rate for Payer: Multiplan Medicare/VA |
$88.41
|
| Rate for Payer: One Health Plan of WY PPO |
$138.18
|
| Rate for Payer: PacificSource Commercial |
$126.90
|
| Rate for Payer: PHCS PPO |
$138.18
|
| Rate for Payer: Three Rivers PPO |
$105.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$122.67
|
| Rate for Payer: United Healthcare Medicare |
$93.06
|
| Rate for Payer: WINHealth Partners Commercial |
$133.95
|
| Rate for Payer: Wise Provider Network Commercial |
$133.95
|
|
|
HC SONO EXAM, HYSTEROSONOGRAPHY - US PELVIS HYSTEROSONOGRAPHY DOPPLER
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 76831
|
| Hospital Charge Code |
4027683101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$492.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$518.10
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$492.20
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$518.10
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$518.10
|
| Rate for Payer: WINHealth Partners Commercial |
$745.75
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC SONO EXAM, HYSTEROSONOGRAPHY - US PELVIS HYSTEROSONOGRAPHY DOPPLER
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 76831
|
| Hospital Charge Code |
4027683101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$432.54 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Aetna of WY Medicare |
$518.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.30
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$432.54
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$455.30
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$455.30
|
| Rate for Payer: WINHealth Partners Commercial |
$769.30
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.90
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$354.26
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.90
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$372.90
|
| Rate for Payer: WINHealth Partners Commercial |
$536.75
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$311.32 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Aetna of WY Medicare |
$372.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.70
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$311.32
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$327.70
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$327.70
|
| Rate for Payer: WINHealth Partners Commercial |
$553.70
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED FOLLICLES
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685702
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$311.32 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Aetna of WY Medicare |
$372.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.70
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$311.32
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$327.70
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$327.70
|
| Rate for Payer: WINHealth Partners Commercial |
$553.70
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED FOLLICLES
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685702
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.90
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$354.26
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.90
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$372.90
|
| Rate for Payer: WINHealth Partners Commercial |
$536.75
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
