|
CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
99292
|
| Min. Negotiated Rate |
$86.84 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.98
|
| Rate for Payer: Aetna of WY Medicare |
$102.16
|
| Rate for Payer: Beech Street Commercial |
$1,235.95
|
| Rate for Payer: Cash Price |
$910.70
|
| Rate for Payer: Cash Price |
$910.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.97
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.98
|
| Rate for Payer: First Choice Health Commercial |
$1,170.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.16
|
| Rate for Payer: HealthUtah PPO |
$1,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.97
|
| Rate for Payer: Multiplan Medicare/VA |
$86.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.98
|
| Rate for Payer: PacificSource Commercial |
$1,170.90
|
| Rate for Payer: PHCS PPO |
$1,235.95
|
| Rate for Payer: Three Rivers PPO |
$975.75
|
| Rate for Payer: TriWest Veterans Administration |
$102.16
|
| Rate for Payer: United Healthcare Commercial |
$1,131.87
|
| Rate for Payer: United Healthcare Medicare |
$102.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.95
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
99291
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$1,814.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,777.72
|
| Rate for Payer: Aetna of WY Medicare |
$203.03
|
| Rate for Payer: Beech Street Commercial |
$1,723.30
|
| Rate for Payer: Cash Price |
$1,269.80
|
| Rate for Payer: Cash Price |
$1,269.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,759.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,777.72
|
| Rate for Payer: First Choice Health Commercial |
$1,632.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,723.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.03
|
| Rate for Payer: HealthUtah PPO |
$1,814.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,759.58
|
| Rate for Payer: Multiplan Medicare/VA |
$172.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,777.72
|
| Rate for Payer: PacificSource Commercial |
$1,632.60
|
| Rate for Payer: PHCS PPO |
$1,723.30
|
| Rate for Payer: Three Rivers PPO |
$1,360.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.03
|
| Rate for Payer: United Healthcare Commercial |
$1,578.18
|
| Rate for Payer: United Healthcare Medicare |
$203.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,723.30
|
|
|
CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
HCPCS 99466
|
| Hospital Charge Code |
99466
|
| Min. Negotiated Rate |
$188.81 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
| Rate for Payer: Aetna of WY Medicare |
$222.13
|
| Rate for Payer: Beech Street Commercial |
$642.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$655.72
|
| Rate for Payer: Cigna of WY Commercial |
$662.48
|
| Rate for Payer: First Choice Health Commercial |
$608.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.13
|
| Rate for Payer: HealthUtah PPO |
$676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
| Rate for Payer: Multiplan Medicare/VA |
$188.81
|
| Rate for Payer: One Health Plan of WY PPO |
$662.48
|
| Rate for Payer: PacificSource Commercial |
$608.40
|
| Rate for Payer: PHCS PPO |
$642.20
|
| Rate for Payer: Three Rivers PPO |
$507.00
|
| Rate for Payer: TriWest Veterans Administration |
$222.13
|
| Rate for Payer: United Healthcare Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicare |
$222.13
|
| Rate for Payer: WINHealth Partners Commercial |
$642.20
|
|
|
CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 99467
|
| Hospital Charge Code |
99467
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$466.45
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: First Choice Health Commercial |
$441.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.51
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$94.78
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$466.45
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$111.51
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$111.51
|
| Rate for Payer: WINHealth Partners Commercial |
$466.45
|
|
|
CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS
|
Professional
|
Both
|
$5,315.00
|
|
|
Service Code
|
HCPCS 62223 AS
|
| Hospital Charge Code |
62223
|
| Min. Negotiated Rate |
$840.48 |
| Max. Negotiated Rate |
$5,315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,208.70
|
| Rate for Payer: Aetna of WY Medicare |
$988.80
|
| Rate for Payer: Beech Street Commercial |
$5,049.25
|
| Rate for Payer: Cash Price |
$3,720.50
|
| Rate for Payer: Cash Price |
$3,720.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,155.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,208.70
|
| Rate for Payer: First Choice Health Commercial |
$4,783.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,049.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$988.80
|
| Rate for Payer: HealthUtah PPO |
$5,315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,155.55
|
| Rate for Payer: Multiplan Medicare/VA |
$840.48
|
| Rate for Payer: One Health Plan of WY PPO |
$5,208.70
|
| Rate for Payer: PacificSource Commercial |
$4,783.50
|
| Rate for Payer: PHCS PPO |
$5,049.25
|
| Rate for Payer: Three Rivers PPO |
$3,986.25
|
| Rate for Payer: TriWest Veterans Administration |
$988.80
|
| Rate for Payer: United Healthcare Commercial |
$4,624.05
|
| Rate for Payer: United Healthcare Medicare |
$988.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,517.75
|
|
|
CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS
|
Professional
|
Both
|
$5,315.00
|
|
|
Service Code
|
HCPCS 62223 80
|
| Hospital Charge Code |
62223
|
| Min. Negotiated Rate |
$840.48 |
| Max. Negotiated Rate |
$5,315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,208.70
|
| Rate for Payer: Aetna of WY Medicare |
$988.80
|
| Rate for Payer: Beech Street Commercial |
$5,049.25
|
| Rate for Payer: Cash Price |
$3,720.50
|
| Rate for Payer: Cash Price |
$3,720.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,155.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,208.70
|
| Rate for Payer: First Choice Health Commercial |
$4,783.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,049.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$988.80
|
| Rate for Payer: HealthUtah PPO |
$5,315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,155.55
|
| Rate for Payer: Multiplan Medicare/VA |
$840.48
|
| Rate for Payer: One Health Plan of WY PPO |
$5,208.70
|
| Rate for Payer: PacificSource Commercial |
$4,783.50
|
| Rate for Payer: PHCS PPO |
$5,049.25
|
| Rate for Payer: Three Rivers PPO |
$3,986.25
|
| Rate for Payer: TriWest Veterans Administration |
$988.80
|
| Rate for Payer: United Healthcare Commercial |
$4,624.05
|
| Rate for Payer: United Healthcare Medicare |
$988.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,517.75
|
|
|
CRUTCH FOREARM PAIR
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS E0110
|
| Hospital Charge Code |
E0110
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Beech Street Commercial |
$27.55
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: First Choice Health Commercial |
$26.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$27.55
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: WINHealth Partners Commercial |
$27.55
|
|
|
CRUTCH MEDIUM 5'2"-5'10"
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.36
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.14
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$24.36
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$24.36
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
CRUTCH MEDIUM 5'2"-5'10"
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$26.33
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
CRUTCH TALL 5'10"-6'6"
|
Facility
|
IP
|
$47.25
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.36
|
| Rate for Payer: Altius Commercial |
$45.36
|
| Rate for Payer: Beech Street Commercial |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.79
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.83
|
| Rate for Payer: Cigna of WY Commercial |
$46.30
|
| Rate for Payer: Entrust Commercial |
$44.89
|
| Rate for Payer: First Choice Health Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.18
|
| Rate for Payer: HealthUtah PPO |
$47.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.83
|
| Rate for Payer: Multiplan Medicare/VA |
$29.63
|
| Rate for Payer: One Health Plan of WY PPO |
$46.30
|
| Rate for Payer: PacificSource Commercial |
$42.52
|
| Rate for Payer: PHCS PPO |
$46.30
|
| Rate for Payer: Three Rivers PPO |
$35.44
|
| Rate for Payer: TriWest Veterans Administration |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$41.11
|
| Rate for Payer: United Healthcare Medicare |
$31.18
|
| Rate for Payer: WINHealth Partners Commercial |
$44.89
|
| Rate for Payer: Wise Provider Network Commercial |
$44.89
|
|
|
CRUTCH TALL 5'10"-6'6"
|
Facility
|
OP
|
$47.25
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.30
|
| Rate for Payer: Aetna of WY Medicare |
$31.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.36
|
| Rate for Payer: Altius Commercial |
$45.36
|
| Rate for Payer: Beech Street Commercial |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.79
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.83
|
| Rate for Payer: Cigna of WY Commercial |
$46.30
|
| Rate for Payer: Entrust Commercial |
$44.89
|
| Rate for Payer: First Choice Health Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.40
|
| Rate for Payer: HealthUtah PPO |
$47.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.83
|
| Rate for Payer: Multiplan Medicare/VA |
$26.03
|
| Rate for Payer: One Health Plan of WY PPO |
$46.30
|
| Rate for Payer: PacificSource Commercial |
$42.52
|
| Rate for Payer: PHCS PPO |
$46.30
|
| Rate for Payer: Three Rivers PPO |
$35.44
|
| Rate for Payer: TriWest Veterans Administration |
$27.40
|
| Rate for Payer: United Healthcare Commercial |
$41.11
|
| Rate for Payer: United Healthcare Medicare |
$27.40
|
| Rate for Payer: WINHealth Partners Commercial |
$46.30
|
| Rate for Payer: Wise Provider Network Commercial |
$44.89
|
|
|
CRUTCH YOUTH 4'6"-5'2"
|
Facility
|
IP
|
$41.56
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.90
|
| Rate for Payer: Altius Commercial |
$39.90
|
| Rate for Payer: Beech Street Commercial |
$40.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.12
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.31
|
| Rate for Payer: Cigna of WY Commercial |
$40.73
|
| Rate for Payer: Entrust Commercial |
$39.48
|
| Rate for Payer: First Choice Health Commercial |
$39.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.43
|
| Rate for Payer: HealthUtah PPO |
$41.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.31
|
| Rate for Payer: Multiplan Medicare/VA |
$26.06
|
| Rate for Payer: One Health Plan of WY PPO |
$40.73
|
| Rate for Payer: PacificSource Commercial |
$37.40
|
| Rate for Payer: PHCS PPO |
$40.73
|
| Rate for Payer: Three Rivers PPO |
$31.17
|
| Rate for Payer: TriWest Veterans Administration |
$27.43
|
| Rate for Payer: United Healthcare Commercial |
$36.16
|
| Rate for Payer: United Healthcare Medicare |
$27.43
|
| Rate for Payer: WINHealth Partners Commercial |
$39.48
|
| Rate for Payer: Wise Provider Network Commercial |
$39.48
|
|
|
CRUTCH YOUTH 4'6"-5'2"
|
Facility
|
OP
|
$41.56
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.73
|
| Rate for Payer: Aetna of WY Medicare |
$27.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.90
|
| Rate for Payer: Altius Commercial |
$39.90
|
| Rate for Payer: Beech Street Commercial |
$40.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.12
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.31
|
| Rate for Payer: Cigna of WY Commercial |
$40.73
|
| Rate for Payer: Entrust Commercial |
$39.48
|
| Rate for Payer: First Choice Health Commercial |
$39.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.10
|
| Rate for Payer: HealthUtah PPO |
$41.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.31
|
| Rate for Payer: Multiplan Medicare/VA |
$22.90
|
| Rate for Payer: One Health Plan of WY PPO |
$40.73
|
| Rate for Payer: PacificSource Commercial |
$37.40
|
| Rate for Payer: PHCS PPO |
$40.73
|
| Rate for Payer: Three Rivers PPO |
$31.17
|
| Rate for Payer: TriWest Veterans Administration |
$24.10
|
| Rate for Payer: United Healthcare Commercial |
$36.16
|
| Rate for Payer: United Healthcare Medicare |
$24.10
|
| Rate for Payer: WINHealth Partners Commercial |
$40.73
|
| Rate for Payer: Wise Provider Network Commercial |
$39.48
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
17340
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$47.36
|
| Rate for Payer: Beech Street Commercial |
$233.70
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: First Choice Health Commercial |
$221.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.36
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$40.26
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$233.70
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.36
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$47.36
|
| Rate for Payer: WINHealth Partners Commercial |
$209.10
|
|
|
C-SECTION PACK
|
Facility
|
IP
|
$220.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.22 |
| Max. Negotiated Rate |
$220.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.63
|
| Rate for Payer: Altius Commercial |
$211.63
|
| Rate for Payer: Beech Street Commercial |
$216.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.99
|
| Rate for Payer: Cash Price |
$154.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.84
|
| Rate for Payer: Cigna of WY Commercial |
$216.04
|
| Rate for Payer: Entrust Commercial |
$209.43
|
| Rate for Payer: First Choice Health Commercial |
$209.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.50
|
| Rate for Payer: HealthUtah PPO |
$220.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.84
|
| Rate for Payer: Multiplan Medicare/VA |
$138.22
|
| Rate for Payer: One Health Plan of WY PPO |
$216.04
|
| Rate for Payer: PacificSource Commercial |
$198.40
|
| Rate for Payer: PHCS PPO |
$216.04
|
| Rate for Payer: Three Rivers PPO |
$165.34
|
| Rate for Payer: TriWest Veterans Administration |
$145.50
|
| Rate for Payer: United Healthcare Commercial |
$191.79
|
| Rate for Payer: United Healthcare Medicare |
$145.50
|
| Rate for Payer: WINHealth Partners Commercial |
$209.43
|
| Rate for Payer: Wise Provider Network Commercial |
$209.43
|
|
|
C-SECTION PACK
|
Facility
|
OP
|
$220.45
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$220.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.04
|
| Rate for Payer: Aetna of WY Medicare |
$145.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.63
|
| Rate for Payer: Altius Commercial |
$211.63
|
| Rate for Payer: Beech Street Commercial |
$216.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.99
|
| Rate for Payer: Cash Price |
$154.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.84
|
| Rate for Payer: Cigna of WY Commercial |
$216.04
|
| Rate for Payer: Entrust Commercial |
$209.43
|
| Rate for Payer: First Choice Health Commercial |
$209.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.86
|
| Rate for Payer: HealthUtah PPO |
$220.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.84
|
| Rate for Payer: Multiplan Medicare/VA |
$121.47
|
| Rate for Payer: One Health Plan of WY PPO |
$216.04
|
| Rate for Payer: PacificSource Commercial |
$198.40
|
| Rate for Payer: PHCS PPO |
$216.04
|
| Rate for Payer: Three Rivers PPO |
$165.34
|
| Rate for Payer: TriWest Veterans Administration |
$127.86
|
| Rate for Payer: United Healthcare Commercial |
$191.79
|
| Rate for Payer: United Healthcare Medicare |
$127.86
|
| Rate for Payer: WINHealth Partners Commercial |
$216.04
|
| Rate for Payer: Wise Provider Network Commercial |
$209.43
|
|
|
CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Hospital Charge Code |
75571
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.68
|
| Rate for Payer: Aetna of WY Medicare |
$26.27
|
| Rate for Payer: Beech Street Commercial |
$347.70
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.02
|
| Rate for Payer: Cigna of WY Commercial |
$358.68
|
| Rate for Payer: First Choice Health Commercial |
$329.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.27
|
| Rate for Payer: HealthUtah PPO |
$366.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.02
|
| Rate for Payer: Multiplan Medicare/VA |
$22.33
|
| Rate for Payer: One Health Plan of WY PPO |
$358.68
|
| Rate for Payer: PacificSource Commercial |
$329.40
|
| Rate for Payer: PHCS PPO |
$347.70
|
| Rate for Payer: Three Rivers PPO |
$274.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.27
|
| Rate for Payer: United Healthcare Commercial |
$318.42
|
| Rate for Payer: United Healthcare Medicare |
$26.27
|
| Rate for Payer: WINHealth Partners Commercial |
$347.70
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30905
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$1,217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,192.66
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$1,156.15
|
| Rate for Payer: Cash Price |
$851.90
|
| Rate for Payer: Cash Price |
$851.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,180.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,192.66
|
| Rate for Payer: First Choice Health Commercial |
$1,095.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,156.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$1,217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,180.49
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,192.66
|
| Rate for Payer: PacificSource Commercial |
$1,095.30
|
| Rate for Payer: PHCS PPO |
$1,156.15
|
| Rate for Payer: Three Rivers PPO |
$912.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$1,058.79
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,034.45
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Professional
|
Both
|
$1,264.00
|
|
|
Service Code
|
HCPCS 30905 50
|
| Hospital Charge Code |
30905
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,238.72
|
| Rate for Payer: Aetna of WY Medicare |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$1,200.80
|
| Rate for Payer: Cash Price |
$884.80
|
| Rate for Payer: Cash Price |
$884.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,226.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,238.72
|
| Rate for Payer: First Choice Health Commercial |
$1,137.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,200.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.48
|
| Rate for Payer: HealthUtah PPO |
$1,264.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,226.08
|
| Rate for Payer: Multiplan Medicare/VA |
$85.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,238.72
|
| Rate for Payer: PacificSource Commercial |
$1,137.60
|
| Rate for Payer: PHCS PPO |
$1,200.80
|
| Rate for Payer: Three Rivers PPO |
$948.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.48
|
| Rate for Payer: United Healthcare Commercial |
$1,099.68
|
| Rate for Payer: United Healthcare Medicare |
$100.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,074.40
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$2,611.00
|
|
|
Service Code
|
HCPCS 30906 50
|
| Hospital Charge Code |
30906
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$2,611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,558.78
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$2,480.45
|
| Rate for Payer: Cash Price |
$1,827.70
|
| Rate for Payer: Cash Price |
$1,827.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,532.67
|
| Rate for Payer: Cigna of WY Commercial |
$2,558.78
|
| Rate for Payer: First Choice Health Commercial |
$2,349.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,480.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$2,611.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,532.67
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2,558.78
|
| Rate for Payer: PacificSource Commercial |
$2,349.90
|
| Rate for Payer: PHCS PPO |
$2,480.45
|
| Rate for Payer: Three Rivers PPO |
$1,958.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,271.57
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,219.35
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
30906
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$1,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,279.88
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$1,240.70
|
| Rate for Payer: Cash Price |
$914.20
|
| Rate for Payer: Cash Price |
$914.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,266.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,279.88
|
| Rate for Payer: First Choice Health Commercial |
$1,175.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,240.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$1,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,266.82
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,279.88
|
| Rate for Payer: PacificSource Commercial |
$1,175.40
|
| Rate for Payer: PHCS PPO |
$1,240.70
|
| Rate for Payer: Three Rivers PPO |
$979.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$1,136.22
|
| Rate for Payer: United Healthcare Medicare |
$126.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,110.10
|
|
|
CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
42962
|
| Min. Negotiated Rate |
$427.94 |
| Max. Negotiated Rate |
$2,637.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,584.26
|
| Rate for Payer: Aetna of WY Medicare |
$503.46
|
| Rate for Payer: Beech Street Commercial |
$2,505.15
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,557.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,584.26
|
| Rate for Payer: First Choice Health Commercial |
$2,373.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,505.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$503.46
|
| Rate for Payer: HealthUtah PPO |
$2,637.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,557.89
|
| Rate for Payer: Multiplan Medicare/VA |
$427.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,584.26
|
| Rate for Payer: PacificSource Commercial |
$2,373.30
|
| Rate for Payer: PHCS PPO |
$2,505.15
|
| Rate for Payer: Three Rivers PPO |
$1,977.75
|
| Rate for Payer: TriWest Veterans Administration |
$503.46
|
| Rate for Payer: United Healthcare Commercial |
$2,294.19
|
| Rate for Payer: United Healthcare Medicare |
$503.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,241.45
|
|
|
CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
59160
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$538.02
|
| Rate for Payer: Aetna of WY Medicare |
$180.03
|
| Rate for Payer: Beech Street Commercial |
$521.55
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$532.53
|
| Rate for Payer: Cigna of WY Commercial |
$538.02
|
| Rate for Payer: First Choice Health Commercial |
$494.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$521.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.03
|
| Rate for Payer: HealthUtah PPO |
$549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$532.53
|
| Rate for Payer: Multiplan Medicare/VA |
$153.03
|
| Rate for Payer: One Health Plan of WY PPO |
$538.02
|
| Rate for Payer: PacificSource Commercial |
$494.10
|
| Rate for Payer: PHCS PPO |
$521.55
|
| Rate for Payer: Three Rivers PPO |
$411.75
|
| Rate for Payer: TriWest Veterans Administration |
$180.03
|
| Rate for Payer: United Healthcare Commercial |
$477.63
|
| Rate for Payer: United Healthcare Medicare |
$180.03
|
| Rate for Payer: WINHealth Partners Commercial |
$466.65
|
|
|
CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
93018
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$13.34
|
| Rate for Payer: Beech Street Commercial |
$156.75
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: First Choice Health Commercial |
$148.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$11.34
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$156.75
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
|
|
CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 93016
|
| Hospital Charge Code |
93016
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$20.22
|
| Rate for Payer: Beech Street Commercial |
$207.10
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: First Choice Health Commercial |
$196.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.22
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$17.19
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$207.10
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.22
|
| Rate for Payer: United Healthcare Commercial |
$189.66
|
| Rate for Payer: United Healthcare Medicare |
$20.22
|
| Rate for Payer: WINHealth Partners Commercial |
$207.10
|
|
