|
HC SPERM ANTIBODY IGG
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 89325
|
| Hospital Charge Code |
3008932502
|
|
Hospital Revenue Code
|
300
|
| 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 SPERM WASHING ARTIFICIAL INSEMINATION
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 58323
|
| Hospital Charge Code |
5105832301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.69
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC SPERM WASHING ARTIFICIAL INSEMINATION
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 58323
|
| Hospital Charge Code |
5105832301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.38
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$26.96
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.38
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$28.38
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC SPINAL/EPIDURAL SET
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
3700000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC SPINAL/EPIDURAL SET
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
3700000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
7616227001
|
|
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 SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
7616227001
|
|
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 SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
3206227001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,567.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,650.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,375.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
3206227001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,377.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,650.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,377.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,450.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC SPINAL PUNCTURE,THERAPEUTIC DRAINAGE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
7616227201
|
|
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 SPINAL PUNCTURE,THERAPEUTIC DRAINAGE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
7616227201
|
|
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 SPUTUM ANALYSIS FOR DIAG TESTING
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 89220
|
| Hospital Charge Code |
3008922001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$608.19 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.20
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$608.19
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$640.20
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$640.20
|
| Rate for Payer: WINHealth Partners Commercial |
$921.50
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC SPUTUM ANALYSIS FOR DIAG TESTING
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 89220
|
| Hospital Charge Code |
3008922001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$534.47 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Aetna of WY Medicare |
$640.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.60
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$534.47
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.60
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$562.60
|
| Rate for Payer: WINHealth Partners Commercial |
$950.60
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC STOMACH SURGERY PROCEDURE UNLISTED
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
7614399901
|
|
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 STOMACH SURGERY PROCEDURE UNLISTED
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 43999
|
| Hospital Charge Code |
7614399901
|
|
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 STONE ANALYSIS
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC STONE ANALYSIS
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
5102954001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
HC STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
5102954001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
HC STRAPPING ANKLE/FOOT
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4202954001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC STRAPPING ANKLE/FOOT
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
4202954001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC STRAPPING; ANKLE &/OR FOOT
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
7612954001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC STRAPPING; ANKLE &/OR FOOT
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
7612954001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC STRAPPING ELBOW/WRIST
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
5102926001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.20
|
| Rate for Payer: Altius Commercial |
$19.20
|
| Rate for Payer: Beech Street Commercial |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: Entrust Commercial |
$19.00
|
| Rate for Payer: First Choice Health Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.20
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$12.54
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.60
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.20
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
| Rate for Payer: Wise Provider Network Commercial |
$19.00
|
|
|
HC STRAPPING ELBOW/WRIST
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
7612926001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
