|
THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 97150
|
| Hospital Charge Code |
97150
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$17.60
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.60
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$14.96
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$17.60
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$17.60
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
96372
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$13.99
|
| Rate for Payer: Beech Street Commercial |
$31.35
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: First Choice Health Commercial |
$29.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.99
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.89
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$31.35
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.99
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$13.99
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
|
|
THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
97110
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$28.73
|
| Rate for Payer: Beech Street Commercial |
$213.75
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: First Choice Health Commercial |
$202.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.73
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$24.42
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$213.75
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.73
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$28.73
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
|
|
THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
62272
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.96
|
| Rate for Payer: Aetna of WY Medicare |
$86.12
|
| Rate for Payer: Beech Street Commercial |
$429.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$438.44
|
| Rate for Payer: Cigna of WY Commercial |
$442.96
|
| Rate for Payer: First Choice Health Commercial |
$406.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$429.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.12
|
| Rate for Payer: HealthUtah PPO |
$452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$438.44
|
| Rate for Payer: Multiplan Medicare/VA |
$73.20
|
| Rate for Payer: One Health Plan of WY PPO |
$442.96
|
| Rate for Payer: PacificSource Commercial |
$406.80
|
| Rate for Payer: PHCS PPO |
$429.40
|
| Rate for Payer: Three Rivers PPO |
$339.00
|
| Rate for Payer: TriWest Veterans Administration |
$86.12
|
| Rate for Payer: United Healthcare Commercial |
$393.24
|
| Rate for Payer: United Healthcare Medicare |
$86.12
|
| Rate for Payer: WINHealth Partners Commercial |
$384.20
|
|
|
THERASHELL NIPPLE SHIELD 89930
|
Facility
|
OP
|
$18.36
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.99
|
| Rate for Payer: Aetna of WY Medicare |
$12.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.63
|
| Rate for Payer: Altius Commercial |
$17.63
|
| Rate for Payer: Beech Street Commercial |
$17.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.81
|
| Rate for Payer: Cigna of WY Commercial |
$17.99
|
| Rate for Payer: Entrust Commercial |
$17.44
|
| Rate for Payer: First Choice Health Commercial |
$17.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.65
|
| Rate for Payer: HealthUtah PPO |
$18.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.81
|
| Rate for Payer: Multiplan Medicare/VA |
$10.12
|
| Rate for Payer: One Health Plan of WY PPO |
$17.99
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.99
|
| Rate for Payer: Three Rivers PPO |
$13.77
|
| Rate for Payer: TriWest Veterans Administration |
$10.65
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$10.65
|
| Rate for Payer: WINHealth Partners Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$17.44
|
|
|
THERASHELL NIPPLE SHIELD 89930
|
Facility
|
IP
|
$18.36
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.63
|
| Rate for Payer: Altius Commercial |
$17.63
|
| Rate for Payer: Beech Street Commercial |
$17.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.07
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.81
|
| Rate for Payer: Cigna of WY Commercial |
$17.99
|
| Rate for Payer: Entrust Commercial |
$17.44
|
| Rate for Payer: First Choice Health Commercial |
$17.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.12
|
| Rate for Payer: HealthUtah PPO |
$18.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.81
|
| Rate for Payer: Multiplan Medicare/VA |
$11.51
|
| Rate for Payer: One Health Plan of WY PPO |
$17.99
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.99
|
| Rate for Payer: Three Rivers PPO |
$13.77
|
| Rate for Payer: TriWest Veterans Administration |
$12.12
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$12.12
|
| Rate for Payer: WINHealth Partners Commercial |
$17.44
|
| Rate for Payer: Wise Provider Network Commercial |
$17.44
|
|
|
THERMODILUTION SET UP 2 PORT MANIFOLD
|
Facility
|
OP
|
$67.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$67.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$66.03
|
| Rate for Payer: Aetna of WY Medicare |
$44.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.68
|
| Rate for Payer: Altius Commercial |
$64.68
|
| Rate for Payer: Beech Street Commercial |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.32
|
| Rate for Payer: Cash Price |
$47.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$65.36
|
| Rate for Payer: Cigna of WY Commercial |
$66.03
|
| Rate for Payer: Entrust Commercial |
$64.01
|
| Rate for Payer: First Choice Health Commercial |
$64.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$64.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.08
|
| Rate for Payer: HealthUtah PPO |
$67.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$65.36
|
| Rate for Payer: Multiplan Medicare/VA |
$37.13
|
| Rate for Payer: One Health Plan of WY PPO |
$66.03
|
| Rate for Payer: PacificSource Commercial |
$60.64
|
| Rate for Payer: PHCS PPO |
$66.03
|
| Rate for Payer: Three Rivers PPO |
$50.54
|
| Rate for Payer: TriWest Veterans Administration |
$39.08
|
| Rate for Payer: United Healthcare Commercial |
$58.62
|
| Rate for Payer: United Healthcare Medicare |
$39.08
|
| Rate for Payer: WINHealth Partners Commercial |
$66.03
|
| Rate for Payer: Wise Provider Network Commercial |
$64.01
|
|
|
THERMODILUTION SET UP 2 PORT MANIFOLD
|
Facility
|
IP
|
$67.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$67.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$66.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.68
|
| Rate for Payer: Altius Commercial |
$64.68
|
| Rate for Payer: Beech Street Commercial |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.32
|
| Rate for Payer: Cash Price |
$47.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$65.36
|
| Rate for Payer: Cigna of WY Commercial |
$66.03
|
| Rate for Payer: Entrust Commercial |
$64.01
|
| Rate for Payer: First Choice Health Commercial |
$64.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$64.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.47
|
| Rate for Payer: HealthUtah PPO |
$67.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$65.36
|
| Rate for Payer: Multiplan Medicare/VA |
$42.25
|
| Rate for Payer: One Health Plan of WY PPO |
$66.03
|
| Rate for Payer: PacificSource Commercial |
$60.64
|
| Rate for Payer: PHCS PPO |
$66.03
|
| Rate for Payer: Three Rivers PPO |
$50.54
|
| Rate for Payer: TriWest Veterans Administration |
$44.47
|
| Rate for Payer: United Healthcare Commercial |
$58.62
|
| Rate for Payer: United Healthcare Medicare |
$44.47
|
| Rate for Payer: WINHealth Partners Commercial |
$64.01
|
| Rate for Payer: Wise Provider Network Commercial |
$64.01
|
|
|
THERMODILUTION SWAN GANZ 7FR
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
THERMODILUTION SWAN GANZ 7FR
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
THERM ORAL/RECTAL DIG MDS9950B
|
Facility
|
IP
|
$13.09
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$13.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.57
|
| Rate for Payer: Altius Commercial |
$12.57
|
| Rate for Payer: Beech Street Commercial |
$12.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.70
|
| Rate for Payer: Cigna of WY Commercial |
$12.83
|
| Rate for Payer: Entrust Commercial |
$12.44
|
| Rate for Payer: First Choice Health Commercial |
$12.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$13.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$12.83
|
| Rate for Payer: PacificSource Commercial |
$11.78
|
| Rate for Payer: PHCS PPO |
$12.83
|
| Rate for Payer: Three Rivers PPO |
$9.82
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$11.39
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$12.44
|
| Rate for Payer: Wise Provider Network Commercial |
$12.44
|
|
|
THERM ORAL/RECTAL DIG MDS9950B
|
Facility
|
OP
|
$13.09
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$13.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.83
|
| Rate for Payer: Aetna of WY Medicare |
$8.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.57
|
| Rate for Payer: Altius Commercial |
$12.57
|
| Rate for Payer: Beech Street Commercial |
$12.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.70
|
| Rate for Payer: Cigna of WY Commercial |
$12.83
|
| Rate for Payer: Entrust Commercial |
$12.44
|
| Rate for Payer: First Choice Health Commercial |
$12.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.59
|
| Rate for Payer: HealthUtah PPO |
$13.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.70
|
| Rate for Payer: Multiplan Medicare/VA |
$7.21
|
| Rate for Payer: One Health Plan of WY PPO |
$12.83
|
| Rate for Payer: PacificSource Commercial |
$11.78
|
| Rate for Payer: PHCS PPO |
$12.83
|
| Rate for Payer: Three Rivers PPO |
$9.82
|
| Rate for Payer: TriWest Veterans Administration |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$11.39
|
| Rate for Payer: United Healthcare Medicare |
$7.59
|
| Rate for Payer: WINHealth Partners Commercial |
$12.83
|
| Rate for Payer: Wise Provider Network Commercial |
$12.44
|
|
|
THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
96374
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$257.74
|
| Rate for Payer: Aetna of WY Medicare |
$35.85
|
| Rate for Payer: Beech Street Commercial |
$249.85
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$255.11
|
| Rate for Payer: Cigna of WY Commercial |
$257.74
|
| Rate for Payer: First Choice Health Commercial |
$236.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.85
|
| Rate for Payer: HealthUtah PPO |
$263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$255.11
|
| Rate for Payer: Multiplan Medicare/VA |
$30.47
|
| Rate for Payer: One Health Plan of WY PPO |
$257.74
|
| Rate for Payer: PacificSource Commercial |
$236.70
|
| Rate for Payer: PHCS PPO |
$249.85
|
| Rate for Payer: Three Rivers PPO |
$197.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.85
|
| Rate for Payer: United Healthcare Commercial |
$228.81
|
| Rate for Payer: United Healthcare Medicare |
$35.85
|
| Rate for Payer: WINHealth Partners Commercial |
$249.85
|
|
|
THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 97116
|
| Hospital Charge Code |
97116
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$28.73
|
| Rate for Payer: Beech Street Commercial |
$151.05
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: First Choice Health Commercial |
$143.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.73
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$24.42
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$151.05
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.73
|
| Rate for Payer: United Healthcare Commercial |
$138.33
|
| Rate for Payer: United Healthcare Medicare |
$28.73
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
|
|
THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 97112
|
| Hospital Charge Code |
97112
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$32.99
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.99
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$28.04
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$32.99
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$32.99
|
| Rate for Payer: WINHealth Partners Commercial |
$222.30
|
|
|
THER PX 1/> AREAS EACH 15 MINUTES MASSAGE
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 97124
|
| Hospital Charge Code |
97124
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$29.71
|
| Rate for Payer: Beech Street Commercial |
$113.05
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: First Choice Health Commercial |
$107.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.71
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$25.25
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$113.05
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.71
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$29.71
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
|
|
THIAMINE HCL 100 MG
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
J3411
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$2.26
|
| Rate for Payer: Beech Street Commercial |
$40.85
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: First Choice Health Commercial |
$38.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.26
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.92
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$40.85
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$2.26
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [9871]
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
HCPCS J3411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.76
|
| Rate for Payer: Altius Commercial |
$29.76
|
| Rate for Payer: Altius Commercial |
$32.31
|
| Rate for Payer: Beech Street Commercial |
$32.99
|
| Rate for Payer: Beech Street Commercial |
$30.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Cash Price |
$23.56
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.65
|
| Rate for Payer: Cigna of WY Commercial |
$32.99
|
| Rate for Payer: Cigna of WY Commercial |
$30.38
|
| Rate for Payer: Entrust Commercial |
$29.45
|
| Rate for Payer: Entrust Commercial |
$31.98
|
| Rate for Payer: First Choice Health Commercial |
$29.45
|
| Rate for Payer: First Choice Health Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.46
|
| Rate for Payer: HealthUtah PPO |
$33.66
|
| Rate for Payer: HealthUtah PPO |
$31.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.65
|
| Rate for Payer: Multiplan Medicare/VA |
$21.10
|
| Rate for Payer: Multiplan Medicare/VA |
$19.44
|
| Rate for Payer: One Health Plan of WY PPO |
$32.99
|
| Rate for Payer: One Health Plan of WY PPO |
$30.38
|
| Rate for Payer: PacificSource Commercial |
$30.29
|
| Rate for Payer: PacificSource Commercial |
$27.90
|
| Rate for Payer: PHCS PPO |
$30.38
|
| Rate for Payer: PHCS PPO |
$32.99
|
| Rate for Payer: Three Rivers PPO |
$23.25
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$22.22
|
| Rate for Payer: TriWest Veterans Administration |
$20.46
|
| Rate for Payer: United Healthcare Commercial |
$26.97
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$22.22
|
| Rate for Payer: United Healthcare Medicare |
$20.46
|
| Rate for Payer: WINHealth Partners Commercial |
$29.45
|
| Rate for Payer: WINHealth Partners Commercial |
$31.98
|
| Rate for Payer: Wise Provider Network Commercial |
$29.45
|
| Rate for Payer: Wise Provider Network Commercial |
$31.98
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION [9871]
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
HCPCS J3411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.38
|
| Rate for Payer: Aetna of WY Medicare |
$22.22
|
| Rate for Payer: Aetna of WY Medicare |
$20.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.31
|
| Rate for Payer: Altius Commercial |
$32.31
|
| Rate for Payer: Altius Commercial |
$29.76
|
| Rate for Payer: Beech Street Commercial |
$30.38
|
| Rate for Payer: Beech Street Commercial |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.45
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$23.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.07
|
| Rate for Payer: Cigna of WY Commercial |
$30.38
|
| Rate for Payer: Cigna of WY Commercial |
$32.99
|
| Rate for Payer: Entrust Commercial |
$31.98
|
| Rate for Payer: Entrust Commercial |
$29.45
|
| Rate for Payer: First Choice Health Commercial |
$29.45
|
| Rate for Payer: First Choice Health Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.98
|
| Rate for Payer: HealthUtah PPO |
$31.00
|
| Rate for Payer: HealthUtah PPO |
$33.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.65
|
| Rate for Payer: Multiplan Medicare/VA |
$18.55
|
| Rate for Payer: Multiplan Medicare/VA |
$17.08
|
| Rate for Payer: One Health Plan of WY PPO |
$30.38
|
| Rate for Payer: One Health Plan of WY PPO |
$32.99
|
| Rate for Payer: PacificSource Commercial |
$30.29
|
| Rate for Payer: PacificSource Commercial |
$27.90
|
| Rate for Payer: PHCS PPO |
$30.38
|
| Rate for Payer: PHCS PPO |
$32.99
|
| Rate for Payer: Three Rivers PPO |
$23.25
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$19.52
|
| Rate for Payer: TriWest Veterans Administration |
$17.98
|
| Rate for Payer: United Healthcare Commercial |
$26.97
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$19.52
|
| Rate for Payer: United Healthcare Medicare |
$17.98
|
| Rate for Payer: WINHealth Partners Commercial |
$30.38
|
| Rate for Payer: WINHealth Partners Commercial |
$32.99
|
| Rate for Payer: Wise Provider Network Commercial |
$29.45
|
| Rate for Payer: Wise Provider Network Commercial |
$31.98
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [90254]
|
Facility
|
IP
|
$0.58
|
|
|
Service Code
|
NDC 4843310801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.38
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.36
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET [90254]
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
NDC 4843310801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.57
|
| Rate for Payer: Aetna of WY Medicare |
$0.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.56
|
| Rate for Payer: Altius Commercial |
$0.56
|
| Rate for Payer: Beech Street Commercial |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.56
|
| Rate for Payer: Cigna of WY Commercial |
$0.57
|
| Rate for Payer: Entrust Commercial |
$0.55
|
| Rate for Payer: First Choice Health Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.56
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.57
|
| Rate for Payer: PacificSource Commercial |
$0.52
|
| Rate for Payer: PHCS PPO |
$0.57
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.57
|
| Rate for Payer: Wise Provider Network Commercial |
$0.55
|
|
|
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
32555
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$1,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,616.02
|
| Rate for Payer: Aetna of WY Medicare |
$102.90
|
| Rate for Payer: Beech Street Commercial |
$1,566.55
|
| Rate for Payer: Cash Price |
$1,154.30
|
| Rate for Payer: Cash Price |
$1,154.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,599.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,616.02
|
| Rate for Payer: First Choice Health Commercial |
$1,484.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,566.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.90
|
| Rate for Payer: HealthUtah PPO |
$1,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,599.53
|
| Rate for Payer: Multiplan Medicare/VA |
$87.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,616.02
|
| Rate for Payer: PacificSource Commercial |
$1,484.10
|
| Rate for Payer: PHCS PPO |
$1,566.55
|
| Rate for Payer: Three Rivers PPO |
$1,236.75
|
| Rate for Payer: TriWest Veterans Administration |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$1,434.63
|
| Rate for Payer: United Healthcare Medicare |
$102.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.65
|
|
|
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 32554 50
|
| Hospital Charge Code |
32554
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$929.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$910.42
|
| Rate for Payer: Aetna of WY Medicare |
$83.67
|
| Rate for Payer: Beech Street Commercial |
$882.55
|
| Rate for Payer: Cash Price |
$650.30
|
| Rate for Payer: Cash Price |
$650.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$901.13
|
| Rate for Payer: Cigna of WY Commercial |
$910.42
|
| Rate for Payer: First Choice Health Commercial |
$836.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$882.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.67
|
| Rate for Payer: HealthUtah PPO |
$929.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$901.13
|
| Rate for Payer: Multiplan Medicare/VA |
$71.12
|
| Rate for Payer: One Health Plan of WY PPO |
$910.42
|
| Rate for Payer: PacificSource Commercial |
$836.10
|
| Rate for Payer: PHCS PPO |
$882.55
|
| Rate for Payer: Three Rivers PPO |
$696.75
|
| Rate for Payer: TriWest Veterans Administration |
$83.67
|
| Rate for Payer: United Healthcare Commercial |
$808.23
|
| Rate for Payer: United Healthcare Medicare |
$83.67
|
| Rate for Payer: WINHealth Partners Commercial |
$789.65
|
|
|
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
32554
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$454.72
|
| Rate for Payer: Aetna of WY Medicare |
$83.67
|
| Rate for Payer: Beech Street Commercial |
$440.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$450.08
|
| Rate for Payer: Cigna of WY Commercial |
$454.72
|
| Rate for Payer: First Choice Health Commercial |
$417.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.67
|
| Rate for Payer: HealthUtah PPO |
$464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$450.08
|
| Rate for Payer: Multiplan Medicare/VA |
$71.12
|
| Rate for Payer: One Health Plan of WY PPO |
$454.72
|
| Rate for Payer: PacificSource Commercial |
$417.60
|
| Rate for Payer: PHCS PPO |
$440.80
|
| Rate for Payer: Three Rivers PPO |
$348.00
|
| Rate for Payer: TriWest Veterans Administration |
$83.67
|
| Rate for Payer: United Healthcare Commercial |
$403.68
|
| Rate for Payer: United Healthcare Medicare |
$83.67
|
| Rate for Payer: WINHealth Partners Commercial |
$394.40
|
|
|
THORASEAL CHEST DRAIN
|
Facility
|
IP
|
$103.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$103.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$99.14
|
| Rate for Payer: Altius Commercial |
$99.14
|
| Rate for Payer: Beech Street Commercial |
$101.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.78
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.17
|
| Rate for Payer: Cigna of WY Commercial |
$101.20
|
| Rate for Payer: Entrust Commercial |
$98.11
|
| Rate for Payer: First Choice Health Commercial |
$98.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.16
|
| Rate for Payer: HealthUtah PPO |
$103.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.17
|
| Rate for Payer: Multiplan Medicare/VA |
$64.75
|
| Rate for Payer: One Health Plan of WY PPO |
$101.20
|
| Rate for Payer: PacificSource Commercial |
$92.94
|
| Rate for Payer: PHCS PPO |
$101.20
|
| Rate for Payer: Three Rivers PPO |
$77.45
|
| Rate for Payer: TriWest Veterans Administration |
$68.16
|
| Rate for Payer: United Healthcare Commercial |
$89.84
|
| Rate for Payer: United Healthcare Medicare |
$68.16
|
| Rate for Payer: WINHealth Partners Commercial |
$98.11
|
| Rate for Payer: Wise Provider Network Commercial |
$98.11
|
|
