|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.10
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$79.90
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.10
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$84.10
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
5103641001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC VNPNXR 3 YEARS/> PHYS/QHP SKILL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
5103641001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 36405
|
| Hospital Charge Code |
5103640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Aetna of WY Medicare |
$11.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.86
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Multiplan Medicare/VA |
$9.37
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: TriWest Veterans Administration |
$9.86
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Medicare |
$9.86
|
| Rate for Payer: WINHealth Partners Commercial |
$16.66
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
|
|
HC VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 36405
|
| Hospital Charge Code |
5103640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.32
|
| Rate for Payer: Altius Commercial |
$16.32
|
| Rate for Payer: Beech Street Commercial |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: Entrust Commercial |
$16.15
|
| Rate for Payer: First Choice Health Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.22
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Multiplan Medicare/VA |
$10.66
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$16.66
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.22
|
| Rate for Payer: United Healthcare Commercial |
$14.79
|
| Rate for Payer: United Healthcare Medicare |
$11.22
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.15
|
|
|
HC VOID PRESSURE STUDIES INTRAABDOMINAL
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
5105179701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.06 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$104.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.68
|
| Rate for Payer: Altius Commercial |
$151.68
|
| Rate for Payer: Beech Street Commercial |
$154.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.72
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: Entrust Commercial |
$150.10
|
| Rate for Payer: First Choice Health Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.64
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$87.06
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$154.84
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$91.64
|
| Rate for Payer: United Healthcare Commercial |
$137.46
|
| Rate for Payer: United Healthcare Medicare |
$91.64
|
| Rate for Payer: WINHealth Partners Commercial |
$154.84
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
|
HC VOID PRESSURE STUDIES INTRAABDOMINAL
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
5105179701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.68
|
| Rate for Payer: Altius Commercial |
$151.68
|
| Rate for Payer: Beech Street Commercial |
$154.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.72
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: Entrust Commercial |
$150.10
|
| Rate for Payer: First Choice Health Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.28
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$99.07
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$154.84
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$104.28
|
| Rate for Payer: United Healthcare Commercial |
$137.46
|
| Rate for Payer: United Healthcare Medicare |
$104.28
|
| Rate for Payer: WINHealth Partners Commercial |
$150.10
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
|
HC WBC ALKALINE PHOSPHATASE - LEUKOCYTE ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 85540
|
| Hospital Charge Code |
3058554001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC WBC ALKALINE PHOSPHATASE - LEUKOCYTE ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 85540
|
| Hospital Charge Code |
3058554001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC WBC ANTIBODY IDENTIFICATION - MYELOPEROXIDASE ANTIBODY
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$151.52
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$159.50
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC WBC ANTIBODY IDENTIFICATION - MYELOPEROXIDASE ANTIBODY
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$172.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC WBC ANTIBODY IDENTIFICATION - PROTEINASE 3 ANTIBODY
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602102
|
|
Hospital Revenue Code
|
302
|
| 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 WBC ANTIBODY IDENTIFICATION - PROTEINASE 3 ANTIBODY
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602102
|
|
Hospital Revenue Code
|
302
|
| 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 WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5101176501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Aetna of WY Medicare |
$61.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.94
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$51.24
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.94
|
| Rate for Payer: United Healthcare Commercial |
$80.91
|
| Rate for Payer: United Healthcare Medicare |
$53.94
|
| Rate for Payer: WINHealth Partners Commercial |
$91.14
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC WEDGE EXCISION SKIN NAIL FOLD
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
5101176501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.38
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$58.31
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$80.91
|
| Rate for Payer: United Healthcare Medicare |
$61.38
|
| Rate for Payer: WINHealth Partners Commercial |
$88.35
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE VIRUS ANTIBODY, IGM
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
3028678802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE VIRUS ANTIBODY, IGM
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
3028678802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC WHFO,NO JOINT, PREFABRICATED
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
274L380701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.64
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$35.64
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC WHFO,NO JOINT, PREFABRICATED
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
274L380701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.32
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.75
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$31.32
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC WOUND PREP PED TRK/ARM/LG 1ST 100 CM
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
HCPCS 15002
|
| Hospital Charge Code |
5101500201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$702.87 |
| Max. Negotiated Rate |
$1,121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,098.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,076.16
|
| Rate for Payer: Altius Commercial |
$1,076.16
|
| Rate for Payer: Beech Street Commercial |
$1,098.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$920.34
|
| Rate for Payer: Cash Price |
$784.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,087.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,098.58
|
| Rate for Payer: Entrust Commercial |
$1,064.95
|
| Rate for Payer: First Choice Health Commercial |
$1,064.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.86
|
| Rate for Payer: HealthUtah PPO |
$1,121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,087.37
|
| Rate for Payer: Multiplan Medicare/VA |
$702.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,098.58
|
| Rate for Payer: PacificSource Commercial |
$1,008.90
|
| Rate for Payer: PHCS PPO |
$1,098.58
|
| Rate for Payer: Three Rivers PPO |
$840.75
|
| Rate for Payer: TriWest Veterans Administration |
$739.86
|
| Rate for Payer: United Healthcare Commercial |
$975.27
|
| Rate for Payer: United Healthcare Medicare |
$739.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.95
|
|
