|
HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
3128830901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,140.57 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,028.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,366.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,987.20
|
| Rate for Payer: Altius Commercial |
$1,987.20
|
| Rate for Payer: Beech Street Commercial |
$2,028.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,699.47
|
| Rate for Payer: Cash Price |
$1,449.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,007.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,028.60
|
| Rate for Payer: Entrust Commercial |
$1,966.50
|
| Rate for Payer: First Choice Health Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,200.60
|
| Rate for Payer: HealthUtah PPO |
$2,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,007.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,140.57
|
| Rate for Payer: One Health Plan of WY PPO |
$2,028.60
|
| Rate for Payer: PacificSource Commercial |
$1,863.00
|
| Rate for Payer: PHCS PPO |
$2,028.60
|
| Rate for Payer: Three Rivers PPO |
$1,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,200.60
|
| Rate for Payer: United Healthcare Commercial |
$1,800.90
|
| Rate for Payer: United Healthcare Medicare |
$1,200.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,028.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,966.50
|
|
|
HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
3128830901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,297.89 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,028.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,987.20
|
| Rate for Payer: Altius Commercial |
$1,987.20
|
| Rate for Payer: Beech Street Commercial |
$2,028.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,699.47
|
| Rate for Payer: Cash Price |
$1,449.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,007.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,028.60
|
| Rate for Payer: Entrust Commercial |
$1,966.50
|
| Rate for Payer: First Choice Health Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,966.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,366.20
|
| Rate for Payer: HealthUtah PPO |
$2,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,007.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,297.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2,028.60
|
| Rate for Payer: PacificSource Commercial |
$1,863.00
|
| Rate for Payer: PHCS PPO |
$2,028.60
|
| Rate for Payer: Three Rivers PPO |
$1,552.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,366.20
|
| Rate for Payer: United Healthcare Commercial |
$1,800.90
|
| Rate for Payer: United Healthcare Medicare |
$1,366.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,966.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,966.50
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
3108830703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
3128830701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$304.10 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.10
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$304.10
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$320.10
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
| Rate for Payer: WINHealth Partners Commercial |
$460.75
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
3108830703
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
3128830701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Aetna of WY Medicare |
$320.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.30
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$281.30
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$281.30
|
| Rate for Payer: WINHealth Partners Commercial |
$475.30
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.26 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$974.40
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$833.32
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$588.70
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$559.26
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$588.70
|
| Rate for Payer: United Healthcare Commercial |
$883.05
|
| Rate for Payer: United Healthcare Medicare |
$588.70
|
| Rate for Payer: WINHealth Partners Commercial |
$994.70
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.40 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$974.40
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$833.32
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$636.40
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$883.05
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$964.25
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS G8996
|
| Hospital Charge Code |
440G899601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
HC SWALLOW CURRENT STATUS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS G8996
|
| Hospital Charge Code |
440G899601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
5101110301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); EA ADDL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
5101110301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$14.42
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
5101110201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.62
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
5101110201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC TC99M LABELED RBC TO 30 MIC
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
343A956001
|
|
Hospital Revenue Code
|
343
|
| 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 TC99M LABELED RBC TO 30 MIC
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
343A956001
|
|
Hospital Revenue Code
|
343
|
| 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 TC99M MAA TO 10 MIC
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
343A954001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC TC99M MAA TO 10 MIC
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
343A954001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC TC99M MEBROFENIN TO 15 MIC
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
343A953701
|
|
Hospital Revenue Code
|
343
|
| 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
|
|
