|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
7619295001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.89 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$728.64
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.14
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.94
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$475.89
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$500.94
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$500.94
|
| Rate for Payer: WINHealth Partners Commercial |
$721.05
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
7619295001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.21 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$500.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$728.64
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.14
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.22
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$418.21
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$440.22
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$440.22
|
| Rate for Payer: WINHealth Partners Commercial |
$743.82
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC CARDIOVERSION, ELECTIVE;EXTERN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4819296001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CARDIOVERSION, ELECTIVE;EXTERN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4819296001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,696.10 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,214.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,128.00
|
| Rate for Payer: Altius Commercial |
$4,128.00
|
| Rate for Payer: Beech Street Commercial |
$4,214.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,530.30
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,171.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,214.00
|
| Rate for Payer: Entrust Commercial |
$4,085.00
|
| Rate for Payer: First Choice Health Commercial |
$4,085.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,085.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,838.00
|
| Rate for Payer: HealthUtah PPO |
$4,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,171.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,696.10
|
| Rate for Payer: One Health Plan of WY PPO |
$4,214.00
|
| Rate for Payer: PacificSource Commercial |
$3,870.00
|
| Rate for Payer: PHCS PPO |
$4,214.00
|
| Rate for Payer: Three Rivers PPO |
$3,225.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,838.00
|
| Rate for Payer: United Healthcare Commercial |
$3,741.00
|
| Rate for Payer: United Healthcare Medicare |
$2,838.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,085.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,085.00
|
|
|
HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,369.30 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,214.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,838.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,128.00
|
| Rate for Payer: Altius Commercial |
$4,128.00
|
| Rate for Payer: Beech Street Commercial |
$4,214.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,530.30
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,171.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,214.00
|
| Rate for Payer: Entrust Commercial |
$4,085.00
|
| Rate for Payer: First Choice Health Commercial |
$4,085.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,085.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,494.00
|
| Rate for Payer: HealthUtah PPO |
$4,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,171.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,369.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4,214.00
|
| Rate for Payer: PacificSource Commercial |
$3,870.00
|
| Rate for Payer: PHCS PPO |
$4,214.00
|
| Rate for Payer: Three Rivers PPO |
$3,225.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,494.00
|
| Rate for Payer: United Healthcare Commercial |
$3,741.00
|
| Rate for Payer: United Healthcare Medicare |
$2,494.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,214.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,085.00
|
|
|
HC C-ARM DEVICES
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
3600000037
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HC C-ARM DEVICES
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
3600000037
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HC CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC CASE MANAGEMENT PER 15 MIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS T1016
|
| Hospital Charge Code |
969T101601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$45.73 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.34
|
| Rate for Payer: Aetna of WY Medicare |
$54.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.68
|
| Rate for Payer: Altius Commercial |
$79.68
|
| Rate for Payer: Beech Street Commercial |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.14
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.51
|
| Rate for Payer: Cigna of WY Commercial |
$81.34
|
| Rate for Payer: Entrust Commercial |
$78.85
|
| Rate for Payer: First Choice Health Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.14
|
| Rate for Payer: HealthUtah PPO |
$83.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.51
|
| Rate for Payer: Multiplan Medicare/VA |
$45.73
|
| Rate for Payer: One Health Plan of WY PPO |
$81.34
|
| Rate for Payer: PacificSource Commercial |
$74.70
|
| Rate for Payer: PHCS PPO |
$81.34
|
| Rate for Payer: Three Rivers PPO |
$62.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.14
|
| Rate for Payer: United Healthcare Commercial |
$72.21
|
| Rate for Payer: United Healthcare Medicare |
$48.14
|
| Rate for Payer: WINHealth Partners Commercial |
$81.34
|
| Rate for Payer: Wise Provider Network Commercial |
$78.85
|
|
|
HC CASE MANAGEMENT PER 15 MIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS T1016
|
| Hospital Charge Code |
969T101601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$79.68
|
| Rate for Payer: Altius Commercial |
$79.68
|
| Rate for Payer: Beech Street Commercial |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.14
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.51
|
| Rate for Payer: Cigna of WY Commercial |
$81.34
|
| Rate for Payer: Entrust Commercial |
$78.85
|
| Rate for Payer: First Choice Health Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.78
|
| Rate for Payer: HealthUtah PPO |
$83.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.51
|
| Rate for Payer: Multiplan Medicare/VA |
$52.04
|
| Rate for Payer: One Health Plan of WY PPO |
$81.34
|
| Rate for Payer: PacificSource Commercial |
$74.70
|
| Rate for Payer: PHCS PPO |
$81.34
|
| Rate for Payer: Three Rivers PPO |
$62.25
|
| Rate for Payer: TriWest Veterans Administration |
$54.78
|
| Rate for Payer: United Healthcare Commercial |
$72.21
|
| Rate for Payer: United Healthcare Medicare |
$54.78
|
| Rate for Payer: WINHealth Partners Commercial |
$78.85
|
| Rate for Payer: Wise Provider Network Commercial |
$78.85
|
|
|
HC CASIRIVI AND IMDEVI INFUSION/SUBCUT INJ
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
510M024301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$475.89 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$728.64
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.14
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$500.94
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$475.89
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$500.94
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$500.94
|
| Rate for Payer: WINHealth Partners Commercial |
$721.05
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC CASIRIVI AND IMDEVI INFUSION/SUBCUT INJ
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
510M024301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$418.21 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$500.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$728.64
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$623.14
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.22
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$418.21
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$440.22
|
| Rate for Payer: United Healthcare Commercial |
$660.33
|
| Rate for Payer: United Healthcare Medicare |
$440.22
|
| Rate for Payer: WINHealth Partners Commercial |
$743.82
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
5105834001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.22
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.06
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$63.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
3205834001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$733.59 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,146.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,123.20
|
| Rate for Payer: Altius Commercial |
$1,123.20
|
| Rate for Payer: Beech Street Commercial |
$1,146.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$960.57
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,134.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,146.60
|
| Rate for Payer: Entrust Commercial |
$1,111.50
|
| Rate for Payer: First Choice Health Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$772.20
|
| Rate for Payer: HealthUtah PPO |
$1,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,134.90
|
| Rate for Payer: Multiplan Medicare/VA |
$733.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,146.60
|
| Rate for Payer: PacificSource Commercial |
$1,053.00
|
| Rate for Payer: PHCS PPO |
$1,146.60
|
| Rate for Payer: Three Rivers PPO |
$877.50
|
| Rate for Payer: TriWest Veterans Administration |
$772.20
|
| Rate for Payer: United Healthcare Commercial |
$1,017.90
|
| Rate for Payer: United Healthcare Medicare |
$772.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,111.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,111.50
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
5105834001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.94
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.34
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$71.94
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
3205834001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.67 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,146.60
|
| Rate for Payer: Aetna of WY Medicare |
$772.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,123.20
|
| Rate for Payer: Altius Commercial |
$1,123.20
|
| Rate for Payer: Beech Street Commercial |
$1,146.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$960.57
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,134.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,146.60
|
| Rate for Payer: Entrust Commercial |
$1,111.50
|
| Rate for Payer: First Choice Health Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,111.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.60
|
| Rate for Payer: HealthUtah PPO |
$1,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,134.90
|
| Rate for Payer: Multiplan Medicare/VA |
$644.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,146.60
|
| Rate for Payer: PacificSource Commercial |
$1,053.00
|
| Rate for Payer: PHCS PPO |
$1,146.60
|
| Rate for Payer: Three Rivers PPO |
$877.50
|
| Rate for Payer: TriWest Veterans Administration |
$678.60
|
| Rate for Payer: United Healthcare Commercial |
$1,017.90
|
| Rate for Payer: United Healthcare Medicare |
$678.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,146.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,111.50
|
|
|
HC CATH INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH
|
Facility
|
IP
|
$5,830.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
4819356701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,655.41 |
| Max. Negotiated Rate |
$5,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,713.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,596.80
|
| Rate for Payer: Altius Commercial |
$5,596.80
|
| Rate for Payer: Beech Street Commercial |
$5,713.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,786.43
|
| Rate for Payer: Cash Price |
$4,081.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,655.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,713.40
|
| Rate for Payer: Entrust Commercial |
$5,538.50
|
| Rate for Payer: First Choice Health Commercial |
$5,538.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,538.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,847.80
|
| Rate for Payer: HealthUtah PPO |
$5,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,655.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3,655.41
|
| Rate for Payer: One Health Plan of WY PPO |
$5,713.40
|
| Rate for Payer: PacificSource Commercial |
$5,247.00
|
| Rate for Payer: PHCS PPO |
$5,713.40
|
| Rate for Payer: Three Rivers PPO |
$4,372.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,847.80
|
| Rate for Payer: United Healthcare Commercial |
$5,072.10
|
| Rate for Payer: United Healthcare Medicare |
$3,847.80
|
| Rate for Payer: WINHealth Partners Commercial |
$5,538.50
|
| Rate for Payer: Wise Provider Network Commercial |
$5,538.50
|
|
|
HC CATH INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH
|
Facility
|
OP
|
$5,830.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
4819356701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,212.33 |
| Max. Negotiated Rate |
$5,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,713.40
|
| Rate for Payer: Aetna of WY Medicare |
$3,847.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,596.80
|
| Rate for Payer: Altius Commercial |
$5,596.80
|
| Rate for Payer: Beech Street Commercial |
$5,713.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,786.43
|
| Rate for Payer: Cash Price |
$4,081.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,655.10
|
| Rate for Payer: Cigna of WY Commercial |
$5,713.40
|
| Rate for Payer: Entrust Commercial |
$5,538.50
|
| Rate for Payer: First Choice Health Commercial |
$5,538.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,538.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,381.40
|
| Rate for Payer: HealthUtah PPO |
$5,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,655.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3,212.33
|
| Rate for Payer: One Health Plan of WY PPO |
$5,713.40
|
| Rate for Payer: PacificSource Commercial |
$5,247.00
|
| Rate for Payer: PHCS PPO |
$5,713.40
|
| Rate for Payer: Three Rivers PPO |
$4,372.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,381.40
|
| Rate for Payer: United Healthcare Commercial |
$5,072.10
|
| Rate for Payer: United Healthcare Medicare |
$3,381.40
|
| Rate for Payer: WINHealth Partners Commercial |
$5,713.40
|
| Rate for Payer: Wise Provider Network Commercial |
$5,538.50
|
|
