|
HFO WITHOUT JOINTS PRE CST
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS L3923
|
| Hospital Charge Code |
L3923
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$93.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$93.65
|
| Rate for Payer: Beech Street Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$35.00
|
| 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: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.65
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$79.60
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$47.50
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.65
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$93.65
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
|
|
HFO W/JOINT(S) CF
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
HCPCS L3921
|
| Hospital Charge Code |
L3921
|
| Min. Negotiated Rate |
$295.54 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$466.48
|
| Rate for Payer: Aetna of WY Medicare |
$347.70
|
| Rate for Payer: Beech Street Commercial |
$452.20
|
| Rate for Payer: Cash Price |
$333.20
|
| Rate for Payer: Cash Price |
$333.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$461.72
|
| Rate for Payer: Cigna of WY Commercial |
$466.48
|
| Rate for Payer: First Choice Health Commercial |
$428.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$452.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$347.70
|
| Rate for Payer: HealthUtah PPO |
$476.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$461.72
|
| Rate for Payer: Multiplan Medicare/VA |
$295.54
|
| Rate for Payer: One Health Plan of WY PPO |
$466.48
|
| Rate for Payer: PacificSource Commercial |
$428.40
|
| Rate for Payer: PHCS PPO |
$452.20
|
| Rate for Payer: Three Rivers PPO |
$357.00
|
| Rate for Payer: TriWest Veterans Administration |
$347.70
|
| Rate for Payer: United Healthcare Commercial |
$414.12
|
| Rate for Payer: United Healthcare Medicare |
$347.70
|
| Rate for Payer: WINHealth Partners Commercial |
$452.20
|
|
|
HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 90748
|
| Hospital Charge Code |
90748
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Beech Street Commercial |
$100.70
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: First Choice Health Commercial |
$95.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$100.70
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: United Healthcare Commercial |
$92.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.00
|
|
|
HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
90648
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Beech Street Commercial |
$82.65
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: First Choice Health Commercial |
$78.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$82.65
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: WINHealth Partners Commercial |
$87.00
|
|
|
HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 90645
|
| Hospital Charge Code |
90645
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$18.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$18.27
|
| Rate for Payer: WINHealth Partners Commercial |
$21.00
|
|
|
HIP ABDUCTION WEDGE LG
|
Facility
|
OP
|
$62.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.28
|
| Rate for Payer: Aetna of WY Medicare |
$41.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.03
|
| Rate for Payer: Altius Commercial |
$60.03
|
| Rate for Payer: Beech Street Commercial |
$61.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.34
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.65
|
| Rate for Payer: Cigna of WY Commercial |
$61.28
|
| Rate for Payer: Entrust Commercial |
$59.40
|
| Rate for Payer: First Choice Health Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.27
|
| Rate for Payer: HealthUtah PPO |
$62.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.65
|
| Rate for Payer: Multiplan Medicare/VA |
$34.45
|
| Rate for Payer: One Health Plan of WY PPO |
$61.28
|
| Rate for Payer: PacificSource Commercial |
$56.28
|
| Rate for Payer: PHCS PPO |
$61.28
|
| Rate for Payer: Three Rivers PPO |
$46.90
|
| Rate for Payer: TriWest Veterans Administration |
$36.27
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Medicare |
$36.27
|
| Rate for Payer: WINHealth Partners Commercial |
$61.28
|
| Rate for Payer: Wise Provider Network Commercial |
$59.40
|
|
|
HIP ABDUCTION WEDGE LG
|
Facility
|
IP
|
$62.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.03
|
| Rate for Payer: Altius Commercial |
$60.03
|
| Rate for Payer: Beech Street Commercial |
$61.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.34
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.65
|
| Rate for Payer: Cigna of WY Commercial |
$61.28
|
| Rate for Payer: Entrust Commercial |
$59.40
|
| Rate for Payer: First Choice Health Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.27
|
| Rate for Payer: HealthUtah PPO |
$62.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.65
|
| Rate for Payer: Multiplan Medicare/VA |
$39.21
|
| Rate for Payer: One Health Plan of WY PPO |
$61.28
|
| Rate for Payer: PacificSource Commercial |
$56.28
|
| Rate for Payer: PHCS PPO |
$61.28
|
| Rate for Payer: Three Rivers PPO |
$46.90
|
| Rate for Payer: TriWest Veterans Administration |
$41.27
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Medicare |
$41.27
|
| Rate for Payer: WINHealth Partners Commercial |
$59.40
|
| Rate for Payer: Wise Provider Network Commercial |
$59.40
|
|
|
HIP ABDUCTOR WEDGE MED
|
Facility
|
OP
|
$49.59
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.60
|
| Rate for Payer: Aetna of WY Medicare |
$32.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.61
|
| Rate for Payer: Altius Commercial |
$47.61
|
| Rate for Payer: Beech Street Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.10
|
| Rate for Payer: Cigna of WY Commercial |
$48.60
|
| Rate for Payer: Entrust Commercial |
$47.11
|
| Rate for Payer: First Choice Health Commercial |
$47.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.76
|
| Rate for Payer: HealthUtah PPO |
$49.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.10
|
| Rate for Payer: Multiplan Medicare/VA |
$27.32
|
| Rate for Payer: One Health Plan of WY PPO |
$48.60
|
| Rate for Payer: PacificSource Commercial |
$44.63
|
| Rate for Payer: PHCS PPO |
$48.60
|
| Rate for Payer: Three Rivers PPO |
$37.19
|
| Rate for Payer: TriWest Veterans Administration |
$28.76
|
| Rate for Payer: United Healthcare Commercial |
$43.14
|
| Rate for Payer: United Healthcare Medicare |
$28.76
|
| Rate for Payer: WINHealth Partners Commercial |
$48.60
|
| Rate for Payer: Wise Provider Network Commercial |
$47.11
|
|
|
HIP ABDUCTOR WEDGE MED
|
Facility
|
IP
|
$49.59
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.61
|
| Rate for Payer: Altius Commercial |
$47.61
|
| Rate for Payer: Beech Street Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.10
|
| Rate for Payer: Cigna of WY Commercial |
$48.60
|
| Rate for Payer: Entrust Commercial |
$47.11
|
| Rate for Payer: First Choice Health Commercial |
$47.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.73
|
| Rate for Payer: HealthUtah PPO |
$49.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.10
|
| Rate for Payer: Multiplan Medicare/VA |
$31.09
|
| Rate for Payer: One Health Plan of WY PPO |
$48.60
|
| Rate for Payer: PacificSource Commercial |
$44.63
|
| Rate for Payer: PHCS PPO |
$48.60
|
| Rate for Payer: Three Rivers PPO |
$37.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.73
|
| Rate for Payer: United Healthcare Commercial |
$43.14
|
| Rate for Payer: United Healthcare Medicare |
$32.73
|
| Rate for Payer: WINHealth Partners Commercial |
$47.11
|
| Rate for Payer: Wise Provider Network Commercial |
$47.11
|
|
|
HIP ABDUCTOR WEDGE SM
|
Facility
|
IP
|
$44.01
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.25
|
| Rate for Payer: Altius Commercial |
$42.25
|
| Rate for Payer: Beech Street Commercial |
$43.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.13
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.69
|
| Rate for Payer: Cigna of WY Commercial |
$43.13
|
| Rate for Payer: Entrust Commercial |
$41.81
|
| Rate for Payer: First Choice Health Commercial |
$41.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.05
|
| Rate for Payer: HealthUtah PPO |
$44.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.69
|
| Rate for Payer: Multiplan Medicare/VA |
$27.59
|
| Rate for Payer: One Health Plan of WY PPO |
$43.13
|
| Rate for Payer: PacificSource Commercial |
$39.61
|
| Rate for Payer: PHCS PPO |
$43.13
|
| Rate for Payer: Three Rivers PPO |
$33.01
|
| Rate for Payer: TriWest Veterans Administration |
$29.05
|
| Rate for Payer: United Healthcare Commercial |
$38.29
|
| Rate for Payer: United Healthcare Medicare |
$29.05
|
| Rate for Payer: WINHealth Partners Commercial |
$41.81
|
| Rate for Payer: Wise Provider Network Commercial |
$41.81
|
|
|
HIP ABDUCTOR WEDGE SM
|
Facility
|
OP
|
$44.01
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.13
|
| Rate for Payer: Aetna of WY Medicare |
$29.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.25
|
| Rate for Payer: Altius Commercial |
$42.25
|
| Rate for Payer: Beech Street Commercial |
$43.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.13
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.69
|
| Rate for Payer: Cigna of WY Commercial |
$43.13
|
| Rate for Payer: Entrust Commercial |
$41.81
|
| Rate for Payer: First Choice Health Commercial |
$41.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.53
|
| Rate for Payer: HealthUtah PPO |
$44.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.69
|
| Rate for Payer: Multiplan Medicare/VA |
$24.25
|
| Rate for Payer: One Health Plan of WY PPO |
$43.13
|
| Rate for Payer: PacificSource Commercial |
$39.61
|
| Rate for Payer: PHCS PPO |
$43.13
|
| Rate for Payer: Three Rivers PPO |
$33.01
|
| Rate for Payer: TriWest Veterans Administration |
$25.53
|
| Rate for Payer: United Healthcare Commercial |
$38.29
|
| Rate for Payer: United Healthcare Medicare |
$25.53
|
| Rate for Payer: WINHealth Partners Commercial |
$43.13
|
| Rate for Payer: Wise Provider Network Commercial |
$41.81
|
|
|
HIP CORE DECOMPRESSION
|
Professional
|
Both
|
$6,662.00
|
|
|
Service Code
|
HCPCS S2325
|
| Hospital Charge Code |
S2325
|
| Min. Negotiated Rate |
$4,996.50 |
| Max. Negotiated Rate |
$6,662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,528.76
|
| Rate for Payer: Beech Street Commercial |
$6,328.90
|
| Rate for Payer: Cash Price |
$4,663.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,462.14
|
| Rate for Payer: Cigna of WY Commercial |
$6,528.76
|
| Rate for Payer: First Choice Health Commercial |
$5,995.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,328.90
|
| Rate for Payer: HealthUtah PPO |
$6,662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,462.14
|
| Rate for Payer: One Health Plan of WY PPO |
$6,528.76
|
| Rate for Payer: PacificSource Commercial |
$5,995.80
|
| Rate for Payer: PHCS PPO |
$6,328.90
|
| Rate for Payer: Three Rivers PPO |
$4,996.50
|
| Rate for Payer: United Healthcare Commercial |
$5,795.94
|
| Rate for Payer: WINHealth Partners Commercial |
$6,328.90
|
|
|
HIP REPLACEMENT KIT
|
Facility
|
OP
|
$52.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.69
|
| Rate for Payer: Aetna of WY Medicare |
$34.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.63
|
| Rate for Payer: Altius Commercial |
$50.63
|
| Rate for Payer: Beech Street Commercial |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.30
|
| Rate for Payer: Cash Price |
$36.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.16
|
| Rate for Payer: Cigna of WY Commercial |
$51.69
|
| Rate for Payer: Entrust Commercial |
$50.10
|
| Rate for Payer: First Choice Health Commercial |
$50.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.59
|
| Rate for Payer: HealthUtah PPO |
$52.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.16
|
| Rate for Payer: Multiplan Medicare/VA |
$29.06
|
| Rate for Payer: One Health Plan of WY PPO |
$51.69
|
| Rate for Payer: PacificSource Commercial |
$47.47
|
| Rate for Payer: PHCS PPO |
$51.69
|
| Rate for Payer: Three Rivers PPO |
$39.56
|
| Rate for Payer: TriWest Veterans Administration |
$30.59
|
| Rate for Payer: United Healthcare Commercial |
$45.88
|
| Rate for Payer: United Healthcare Medicare |
$30.59
|
| Rate for Payer: WINHealth Partners Commercial |
$51.69
|
| Rate for Payer: Wise Provider Network Commercial |
$50.10
|
|
|
HIP REPLACEMENT KIT
|
Facility
|
IP
|
$52.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.63
|
| Rate for Payer: Altius Commercial |
$50.63
|
| Rate for Payer: Beech Street Commercial |
$51.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.30
|
| Rate for Payer: Cash Price |
$36.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.16
|
| Rate for Payer: Cigna of WY Commercial |
$51.69
|
| Rate for Payer: Entrust Commercial |
$50.10
|
| Rate for Payer: First Choice Health Commercial |
$50.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.81
|
| Rate for Payer: HealthUtah PPO |
$52.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.16
|
| Rate for Payer: Multiplan Medicare/VA |
$33.07
|
| Rate for Payer: One Health Plan of WY PPO |
$51.69
|
| Rate for Payer: PacificSource Commercial |
$47.47
|
| Rate for Payer: PHCS PPO |
$51.69
|
| Rate for Payer: Three Rivers PPO |
$39.56
|
| Rate for Payer: TriWest Veterans Administration |
$34.81
|
| Rate for Payer: United Healthcare Commercial |
$45.88
|
| Rate for Payer: United Healthcare Medicare |
$34.81
|
| Rate for Payer: WINHealth Partners Commercial |
$50.10
|
| Rate for Payer: Wise Provider Network Commercial |
$50.10
|
|
|
HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
99350
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$178.70
|
| Rate for Payer: Beech Street Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: First Choice Health Commercial |
$266.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.70
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$151.90
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$281.20
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$178.70
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$178.70
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
|
|
HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
99348
|
| Min. Negotiated Rate |
$62.87 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$73.97
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.97
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$62.87
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$73.97
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$73.97
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
|
HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
99349
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$122.73
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.73
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$104.32
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.73
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$122.73
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
|
|
HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
99347
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$43.78
|
| Rate for Payer: Beech Street Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: First Choice Health Commercial |
$138.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$37.21
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$146.30
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.78
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$43.78
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
|
|
HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
99344
|
| Min. Negotiated Rate |
$116.57 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$413.56
|
| Rate for Payer: Aetna of WY Medicare |
$137.14
|
| Rate for Payer: Beech Street Commercial |
$400.90
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$409.34
|
| Rate for Payer: Cigna of WY Commercial |
$413.56
|
| Rate for Payer: First Choice Health Commercial |
$379.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$400.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$137.14
|
| Rate for Payer: HealthUtah PPO |
$422.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$409.34
|
| Rate for Payer: Multiplan Medicare/VA |
$116.57
|
| Rate for Payer: One Health Plan of WY PPO |
$413.56
|
| Rate for Payer: PacificSource Commercial |
$379.80
|
| Rate for Payer: PHCS PPO |
$400.90
|
| Rate for Payer: Three Rivers PPO |
$316.50
|
| Rate for Payer: TriWest Veterans Administration |
$137.14
|
| Rate for Payer: United Healthcare Commercial |
$367.14
|
| Rate for Payer: United Healthcare Medicare |
$137.14
|
| Rate for Payer: WINHealth Partners Commercial |
$400.90
|
|
|
HOOD FLYTE
|
Facility
|
OP
|
$80.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.74
|
| Rate for Payer: Aetna of WY Medicare |
$53.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.14
|
| Rate for Payer: Altius Commercial |
$77.14
|
| Rate for Payer: Beech Street Commercial |
$78.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.97
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.94
|
| Rate for Payer: Cigna of WY Commercial |
$78.74
|
| Rate for Payer: Entrust Commercial |
$76.33
|
| Rate for Payer: First Choice Health Commercial |
$76.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.60
|
| Rate for Payer: HealthUtah PPO |
$80.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.94
|
| Rate for Payer: Multiplan Medicare/VA |
$44.27
|
| Rate for Payer: One Health Plan of WY PPO |
$78.74
|
| Rate for Payer: PacificSource Commercial |
$72.32
|
| Rate for Payer: PHCS PPO |
$78.74
|
| Rate for Payer: Three Rivers PPO |
$60.26
|
| Rate for Payer: TriWest Veterans Administration |
$46.60
|
| Rate for Payer: United Healthcare Commercial |
$69.90
|
| Rate for Payer: United Healthcare Medicare |
$46.60
|
| Rate for Payer: WINHealth Partners Commercial |
$78.74
|
| Rate for Payer: Wise Provider Network Commercial |
$76.33
|
|
|
HOOD FLYTE
|
Facility
|
IP
|
$80.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.14
|
| Rate for Payer: Altius Commercial |
$77.14
|
| Rate for Payer: Beech Street Commercial |
$78.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.97
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.94
|
| Rate for Payer: Cigna of WY Commercial |
$78.74
|
| Rate for Payer: Entrust Commercial |
$76.33
|
| Rate for Payer: First Choice Health Commercial |
$76.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.03
|
| Rate for Payer: HealthUtah PPO |
$80.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.94
|
| Rate for Payer: Multiplan Medicare/VA |
$50.38
|
| Rate for Payer: One Health Plan of WY PPO |
$78.74
|
| Rate for Payer: PacificSource Commercial |
$72.32
|
| Rate for Payer: PHCS PPO |
$78.74
|
| Rate for Payer: Three Rivers PPO |
$60.26
|
| Rate for Payer: TriWest Veterans Administration |
$53.03
|
| Rate for Payer: United Healthcare Commercial |
$69.90
|
| Rate for Payer: United Healthcare Medicare |
$53.03
|
| Rate for Payer: WINHealth Partners Commercial |
$76.33
|
| Rate for Payer: Wise Provider Network Commercial |
$76.33
|
|
|
HOOD T7 PLUS WPEEL AWAY SHIELD
|
Facility
|
IP
|
$124.46
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.04 |
| Max. Negotiated Rate |
$124.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.48
|
| Rate for Payer: Altius Commercial |
$119.48
|
| Rate for Payer: Beech Street Commercial |
$121.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.18
|
| Rate for Payer: Cash Price |
$87.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.73
|
| Rate for Payer: Cigna of WY Commercial |
$121.97
|
| Rate for Payer: Entrust Commercial |
$118.24
|
| Rate for Payer: First Choice Health Commercial |
$118.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.14
|
| Rate for Payer: HealthUtah PPO |
$124.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.73
|
| Rate for Payer: Multiplan Medicare/VA |
$78.04
|
| Rate for Payer: One Health Plan of WY PPO |
$121.97
|
| Rate for Payer: PacificSource Commercial |
$112.01
|
| Rate for Payer: PHCS PPO |
$121.97
|
| Rate for Payer: Three Rivers PPO |
$93.34
|
| Rate for Payer: TriWest Veterans Administration |
$82.14
|
| Rate for Payer: United Healthcare Commercial |
$108.28
|
| Rate for Payer: United Healthcare Medicare |
$82.14
|
| Rate for Payer: WINHealth Partners Commercial |
$118.24
|
| Rate for Payer: Wise Provider Network Commercial |
$118.24
|
|
|
HOOD T7 PLUS WPEEL AWAY SHIELD
|
Facility
|
OP
|
$124.46
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$124.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.97
|
| Rate for Payer: Aetna of WY Medicare |
$82.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.48
|
| Rate for Payer: Altius Commercial |
$119.48
|
| Rate for Payer: Beech Street Commercial |
$121.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.18
|
| Rate for Payer: Cash Price |
$87.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.73
|
| Rate for Payer: Cigna of WY Commercial |
$121.97
|
| Rate for Payer: Entrust Commercial |
$118.24
|
| Rate for Payer: First Choice Health Commercial |
$118.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.19
|
| Rate for Payer: HealthUtah PPO |
$124.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.58
|
| Rate for Payer: One Health Plan of WY PPO |
$121.97
|
| Rate for Payer: PacificSource Commercial |
$112.01
|
| Rate for Payer: PHCS PPO |
$121.97
|
| Rate for Payer: Three Rivers PPO |
$93.34
|
| Rate for Payer: TriWest Veterans Administration |
$72.19
|
| Rate for Payer: United Healthcare Commercial |
$108.28
|
| Rate for Payer: United Healthcare Medicare |
$72.19
|
| Rate for Payer: WINHealth Partners Commercial |
$121.97
|
| Rate for Payer: Wise Provider Network Commercial |
$118.24
|
|
|
HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
99236
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$528.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$528.22
|
| Rate for Payer: Aetna of WY Medicare |
$199.62
|
| Rate for Payer: Beech Street Commercial |
$512.05
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$522.83
|
| Rate for Payer: Cigna of WY Commercial |
$528.22
|
| Rate for Payer: First Choice Health Commercial |
$485.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$512.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.62
|
| Rate for Payer: HealthUtah PPO |
$272.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$522.83
|
| Rate for Payer: Multiplan Medicare/VA |
$169.68
|
| Rate for Payer: One Health Plan of WY PPO |
$528.22
|
| Rate for Payer: PacificSource Commercial |
$485.10
|
| Rate for Payer: PHCS PPO |
$512.05
|
| Rate for Payer: Three Rivers PPO |
$404.25
|
| Rate for Payer: TriWest Veterans Administration |
$199.62
|
| Rate for Payer: United Healthcare Commercial |
$468.93
|
| Rate for Payer: United Healthcare Medicare |
$199.62
|
| Rate for Payer: WINHealth Partners Commercial |
$512.05
|
|
|
HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
99235
|
| Min. Negotiated Rate |
$129.91 |
| Max. Negotiated Rate |
$420.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$420.42
|
| Rate for Payer: Aetna of WY Medicare |
$152.83
|
| Rate for Payer: Beech Street Commercial |
$407.55
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$416.13
|
| Rate for Payer: Cigna of WY Commercial |
$420.42
|
| Rate for Payer: First Choice Health Commercial |
$386.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$407.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.83
|
| Rate for Payer: HealthUtah PPO |
$218.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$416.13
|
| Rate for Payer: Multiplan Medicare/VA |
$129.91
|
| Rate for Payer: One Health Plan of WY PPO |
$420.42
|
| Rate for Payer: PacificSource Commercial |
$386.10
|
| Rate for Payer: PHCS PPO |
$407.55
|
| Rate for Payer: Three Rivers PPO |
$321.75
|
| Rate for Payer: TriWest Veterans Administration |
$152.83
|
| Rate for Payer: United Healthcare Commercial |
$373.23
|
| Rate for Payer: United Healthcare Medicare |
$152.83
|
| Rate for Payer: WINHealth Partners Commercial |
$407.55
|
|
