|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC BRONCHOSCOPY PROCEDURE
|
Facility
|
OP
|
$605.00
|
|
| Hospital Charge Code |
3600000038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.36 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.90
|
| Rate for Payer: Aetna of WY Medicare |
$399.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$580.80
|
| Rate for Payer: Altius Commercial |
$580.80
|
| Rate for Payer: Beech Street Commercial |
$592.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$496.70
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.85
|
| Rate for Payer: Cigna of WY Commercial |
$592.90
|
| Rate for Payer: Entrust Commercial |
$574.75
|
| Rate for Payer: First Choice Health Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.90
|
| Rate for Payer: HealthUtah PPO |
$605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.85
|
| Rate for Payer: Multiplan Medicare/VA |
$333.36
|
| Rate for Payer: One Health Plan of WY PPO |
$592.90
|
| Rate for Payer: PacificSource Commercial |
$544.50
|
| Rate for Payer: PHCS PPO |
$592.90
|
| Rate for Payer: Three Rivers PPO |
$453.75
|
| Rate for Payer: TriWest Veterans Administration |
$350.90
|
| Rate for Payer: United Healthcare Commercial |
$526.35
|
| Rate for Payer: United Healthcare Medicare |
$350.90
|
| Rate for Payer: WINHealth Partners Commercial |
$592.90
|
| Rate for Payer: Wise Provider Network Commercial |
$574.75
|
|
|
HC BRONCHOSCOPY PROCEDURE
|
Facility
|
IP
|
$605.00
|
|
| Hospital Charge Code |
3600000038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.34 |
| Max. Negotiated Rate |
$605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$580.80
|
| Rate for Payer: Altius Commercial |
$580.80
|
| Rate for Payer: Beech Street Commercial |
$592.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$496.70
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.85
|
| Rate for Payer: Cigna of WY Commercial |
$592.90
|
| Rate for Payer: Entrust Commercial |
$574.75
|
| Rate for Payer: First Choice Health Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.30
|
| Rate for Payer: HealthUtah PPO |
$605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.85
|
| Rate for Payer: Multiplan Medicare/VA |
$379.34
|
| Rate for Payer: One Health Plan of WY PPO |
$592.90
|
| Rate for Payer: PacificSource Commercial |
$544.50
|
| Rate for Payer: PHCS PPO |
$592.90
|
| Rate for Payer: Three Rivers PPO |
$453.75
|
| Rate for Payer: TriWest Veterans Administration |
$399.30
|
| Rate for Payer: United Healthcare Commercial |
$526.35
|
| Rate for Payer: United Healthcare Medicare |
$399.30
|
| Rate for Payer: WINHealth Partners Commercial |
$574.75
|
| Rate for Payer: Wise Provider Network Commercial |
$574.75
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$4,795.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,006.46 |
| Max. Negotiated Rate |
$4,795.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,699.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,603.20
|
| Rate for Payer: Altius Commercial |
$4,603.20
|
| Rate for Payer: Beech Street Commercial |
$4,699.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,936.70
|
| Rate for Payer: Cash Price |
$3,356.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,651.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,699.10
|
| Rate for Payer: Entrust Commercial |
$4,555.25
|
| Rate for Payer: First Choice Health Commercial |
$4,555.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,555.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,164.70
|
| Rate for Payer: HealthUtah PPO |
$4,795.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,651.15
|
| Rate for Payer: Multiplan Medicare/VA |
$3,006.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,699.10
|
| Rate for Payer: PacificSource Commercial |
$4,315.50
|
| Rate for Payer: PHCS PPO |
$4,699.10
|
| Rate for Payer: Three Rivers PPO |
$3,596.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,164.70
|
| Rate for Payer: United Healthcare Commercial |
$4,171.65
|
| Rate for Payer: United Healthcare Medicare |
$3,164.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,555.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,555.25
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$4,795.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,642.04 |
| Max. Negotiated Rate |
$4,795.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,699.10
|
| Rate for Payer: Aetna of WY Medicare |
$3,164.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,603.20
|
| Rate for Payer: Altius Commercial |
$4,603.20
|
| Rate for Payer: Beech Street Commercial |
$4,699.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,936.70
|
| Rate for Payer: Cash Price |
$3,356.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,651.15
|
| Rate for Payer: Cigna of WY Commercial |
$4,699.10
|
| Rate for Payer: Entrust Commercial |
$4,555.25
|
| Rate for Payer: First Choice Health Commercial |
$4,555.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,555.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,781.10
|
| Rate for Payer: HealthUtah PPO |
$4,795.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,651.15
|
| Rate for Payer: Multiplan Medicare/VA |
$2,642.04
|
| Rate for Payer: One Health Plan of WY PPO |
$4,699.10
|
| Rate for Payer: PacificSource Commercial |
$4,315.50
|
| Rate for Payer: PHCS PPO |
$4,699.10
|
| Rate for Payer: Three Rivers PPO |
$3,596.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,781.10
|
| Rate for Payer: United Healthcare Commercial |
$4,171.65
|
| Rate for Payer: United Healthcare Medicare |
$2,781.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,699.10
|
| Rate for Payer: Wise Provider Network Commercial |
$4,555.25
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$2,465.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4021908401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,545.56 |
| Max. Negotiated Rate |
$2,465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,415.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,366.40
|
| Rate for Payer: Altius Commercial |
$2,366.40
|
| Rate for Payer: Beech Street Commercial |
$2,415.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,023.76
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,391.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,415.70
|
| Rate for Payer: Entrust Commercial |
$2,341.75
|
| Rate for Payer: First Choice Health Commercial |
$2,341.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,341.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,626.90
|
| Rate for Payer: HealthUtah PPO |
$2,465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,391.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,545.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,415.70
|
| Rate for Payer: PacificSource Commercial |
$2,218.50
|
| Rate for Payer: PHCS PPO |
$2,415.70
|
| Rate for Payer: Three Rivers PPO |
$1,848.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,626.90
|
| Rate for Payer: United Healthcare Commercial |
$2,144.55
|
| Rate for Payer: United Healthcare Medicare |
$1,626.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,341.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,341.75
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$2,830.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
6101908401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,559.33 |
| Max. Negotiated Rate |
$2,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,773.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,867.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,716.80
|
| Rate for Payer: Altius Commercial |
$2,716.80
|
| Rate for Payer: Beech Street Commercial |
$2,773.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,981.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,745.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,773.40
|
| Rate for Payer: Entrust Commercial |
$2,688.50
|
| Rate for Payer: First Choice Health Commercial |
$2,688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,641.40
|
| Rate for Payer: HealthUtah PPO |
$2,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,745.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,559.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,773.40
|
| Rate for Payer: PacificSource Commercial |
$2,547.00
|
| Rate for Payer: PHCS PPO |
$2,773.40
|
| Rate for Payer: Three Rivers PPO |
$2,122.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,641.40
|
| Rate for Payer: United Healthcare Commercial |
$2,462.10
|
| Rate for Payer: United Healthcare Medicare |
$1,641.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,773.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,688.50
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$2,830.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
6101908401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,774.41 |
| Max. Negotiated Rate |
$2,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,773.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,716.80
|
| Rate for Payer: Altius Commercial |
$2,716.80
|
| Rate for Payer: Beech Street Commercial |
$2,773.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,981.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,745.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,773.40
|
| Rate for Payer: Entrust Commercial |
$2,688.50
|
| Rate for Payer: First Choice Health Commercial |
$2,688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,867.80
|
| Rate for Payer: HealthUtah PPO |
$2,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,745.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,774.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,773.40
|
| Rate for Payer: PacificSource Commercial |
$2,547.00
|
| Rate for Payer: PHCS PPO |
$2,773.40
|
| Rate for Payer: Three Rivers PPO |
$2,122.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,867.80
|
| Rate for Payer: United Healthcare Commercial |
$2,462.10
|
| Rate for Payer: United Healthcare Medicare |
$1,867.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,688.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,688.50
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$2,465.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4021908401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,358.22 |
| Max. Negotiated Rate |
$2,465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,415.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,626.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,366.40
|
| Rate for Payer: Altius Commercial |
$2,366.40
|
| Rate for Payer: Beech Street Commercial |
$2,415.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,023.76
|
| Rate for Payer: Cash Price |
$1,725.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,391.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,415.70
|
| Rate for Payer: Entrust Commercial |
$2,341.75
|
| Rate for Payer: First Choice Health Commercial |
$2,341.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,341.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,429.70
|
| Rate for Payer: HealthUtah PPO |
$2,465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,391.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,358.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,415.70
|
| Rate for Payer: PacificSource Commercial |
$2,218.50
|
| Rate for Payer: PHCS PPO |
$2,415.70
|
| Rate for Payer: Three Rivers PPO |
$1,848.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,429.70
|
| Rate for Payer: United Healthcare Commercial |
$2,144.55
|
| Rate for Payer: United Healthcare Medicare |
$1,429.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,415.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,341.75
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC CAM IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.52
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.42
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$23.20
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$24.42
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC CAM IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
6369068601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$24.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.52
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.46
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$20.39
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$22.35
|
| Rate for Payer: WINHealth Partners Commercial |
$36.26
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC CAMS 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
HCPCS 90651 NONPBBPAYER
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$305.98 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$478.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$468.48
|
| Rate for Payer: Altius Commercial |
$468.48
|
| Rate for Payer: Beech Street Commercial |
$478.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$400.65
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$473.36
|
| Rate for Payer: Cigna of WY Commercial |
$478.24
|
| Rate for Payer: Entrust Commercial |
$463.60
|
| Rate for Payer: First Choice Health Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.08
|
| Rate for Payer: HealthUtah PPO |
$488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$473.36
|
| Rate for Payer: Multiplan Medicare/VA |
$305.98
|
| Rate for Payer: One Health Plan of WY PPO |
$478.24
|
| Rate for Payer: PacificSource Commercial |
$439.20
|
| Rate for Payer: PHCS PPO |
$478.24
|
| Rate for Payer: Three Rivers PPO |
$366.00
|
| Rate for Payer: TriWest Veterans Administration |
$322.08
|
| Rate for Payer: United Healthcare Commercial |
$424.56
|
| Rate for Payer: United Healthcare Medicare |
$322.08
|
| Rate for Payer: WINHealth Partners Commercial |
$463.60
|
| Rate for Payer: Wise Provider Network Commercial |
$463.60
|
|
|
HC CAMS 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC CAMS 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS 90651 NONPBBPAYER
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.89 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$478.24
|
| Rate for Payer: Aetna of WY Medicare |
$322.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$468.48
|
| Rate for Payer: Altius Commercial |
$468.48
|
| Rate for Payer: Beech Street Commercial |
$478.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$400.65
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$473.36
|
| Rate for Payer: Cigna of WY Commercial |
$478.24
|
| Rate for Payer: Entrust Commercial |
$463.60
|
| Rate for Payer: First Choice Health Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$283.04
|
| Rate for Payer: HealthUtah PPO |
$488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$473.36
|
| Rate for Payer: Multiplan Medicare/VA |
$268.89
|
| Rate for Payer: One Health Plan of WY PPO |
$478.24
|
| Rate for Payer: PacificSource Commercial |
$439.20
|
| Rate for Payer: PHCS PPO |
$478.24
|
| Rate for Payer: Three Rivers PPO |
$366.00
|
| Rate for Payer: TriWest Veterans Administration |
$283.04
|
| Rate for Payer: United Healthcare Commercial |
$424.56
|
| Rate for Payer: United Healthcare Medicare |
$283.04
|
| Rate for Payer: WINHealth Partners Commercial |
$478.24
|
| Rate for Payer: Wise Provider Network Commercial |
$463.60
|
|
|
HC CAMS 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
6369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC CAMS AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
6369069401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$99.84
|
| Rate for Payer: Altius Commercial |
$99.84
|
| Rate for Payer: Beech Street Commercial |
$101.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85.38
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: Entrust Commercial |
$98.80
|
| Rate for Payer: First Choice Health Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.64
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$65.21
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$101.92
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.64
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$68.64
|
| Rate for Payer: WINHealth Partners Commercial |
$98.80
|
| Rate for Payer: Wise Provider Network Commercial |
$98.80
|
|
|
HC CAMS AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
6369069401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$68.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$99.84
|
| Rate for Payer: Altius Commercial |
$99.84
|
| Rate for Payer: Beech Street Commercial |
$101.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$85.38
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: Entrust Commercial |
$98.80
|
| Rate for Payer: First Choice Health Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.32
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$57.30
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$101.92
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$90.48
|
| Rate for Payer: United Healthcare Medicare |
$77.36
|
| Rate for Payer: WINHealth Partners Commercial |
$101.92
|
| Rate for Payer: Wise Provider Network Commercial |
$98.80
|
|
|
HC CAMS BETAMETHASONE ACET&SOD PHOSP
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
