|
HC CATHJ UMBILICAL VEIN DX/THER NB
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
5103651001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$36.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.76
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.48
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$30.86
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$32.48
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$32.48
|
| Rate for Payer: WINHealth Partners Commercial |
$54.88
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
|
HC CATHJ UMBILICAL VEIN DX/THER NB
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
5103651001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.76
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.96
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$35.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$36.96
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
| Rate for Payer: WINHealth Partners Commercial |
$53.20
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
|
HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,129.55 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,009.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,353.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,968.00
|
| Rate for Payer: Altius Commercial |
$1,968.00
|
| Rate for Payer: Beech Street Commercial |
$2,009.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,683.05
|
| Rate for Payer: Cash Price |
$1,435.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,988.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,009.00
|
| Rate for Payer: Entrust Commercial |
$1,947.50
|
| Rate for Payer: First Choice Health Commercial |
$1,947.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,947.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,189.00
|
| Rate for Payer: HealthUtah PPO |
$2,050.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,988.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,129.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2,009.00
|
| Rate for Payer: PacificSource Commercial |
$1,845.00
|
| Rate for Payer: PHCS PPO |
$2,009.00
|
| Rate for Payer: Three Rivers PPO |
$1,537.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,189.00
|
| Rate for Payer: United Healthcare Commercial |
$1,783.50
|
| Rate for Payer: United Healthcare Medicare |
$1,189.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,009.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,947.50
|
|
|
HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,285.35 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,009.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,968.00
|
| Rate for Payer: Altius Commercial |
$1,968.00
|
| Rate for Payer: Beech Street Commercial |
$2,009.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,683.05
|
| Rate for Payer: Cash Price |
$1,435.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,988.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,009.00
|
| Rate for Payer: Entrust Commercial |
$1,947.50
|
| Rate for Payer: First Choice Health Commercial |
$1,947.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,947.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,353.00
|
| Rate for Payer: HealthUtah PPO |
$2,050.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,988.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,285.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,009.00
|
| Rate for Payer: PacificSource Commercial |
$1,845.00
|
| Rate for Payer: PHCS PPO |
$2,009.00
|
| Rate for Payer: Three Rivers PPO |
$1,537.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,353.00
|
| Rate for Payer: United Healthcare Commercial |
$1,783.50
|
| Rate for Payer: United Healthcare Medicare |
$1,353.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,947.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,947.50
|
|
|
HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST
|
Facility
|
OP
|
$3,070.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
3527126002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,691.57 |
| Max. Negotiated Rate |
$3,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,008.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,026.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,947.20
|
| Rate for Payer: Altius Commercial |
$2,947.20
|
| Rate for Payer: Beech Street Commercial |
$3,008.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,520.47
|
| Rate for Payer: Cash Price |
$2,149.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,977.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,008.60
|
| Rate for Payer: Entrust Commercial |
$2,916.50
|
| Rate for Payer: First Choice Health Commercial |
$2,916.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,916.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,780.60
|
| Rate for Payer: HealthUtah PPO |
$3,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,977.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,691.57
|
| Rate for Payer: One Health Plan of WY PPO |
$3,008.60
|
| Rate for Payer: PacificSource Commercial |
$2,763.00
|
| Rate for Payer: PHCS PPO |
$3,008.60
|
| Rate for Payer: Three Rivers PPO |
$2,302.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,780.60
|
| Rate for Payer: United Healthcare Commercial |
$2,670.90
|
| Rate for Payer: United Healthcare Medicare |
$1,780.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,008.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,916.50
|
|
|
HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST
|
Facility
|
IP
|
$3,070.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
3527126002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,924.89 |
| Max. Negotiated Rate |
$3,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,008.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,947.20
|
| Rate for Payer: Altius Commercial |
$2,947.20
|
| Rate for Payer: Beech Street Commercial |
$3,008.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,520.47
|
| Rate for Payer: Cash Price |
$2,149.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,977.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,008.60
|
| Rate for Payer: Entrust Commercial |
$2,916.50
|
| Rate for Payer: First Choice Health Commercial |
$2,916.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,916.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,026.20
|
| Rate for Payer: HealthUtah PPO |
$3,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,977.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,924.89
|
| Rate for Payer: One Health Plan of WY PPO |
$3,008.60
|
| Rate for Payer: PacificSource Commercial |
$2,763.00
|
| Rate for Payer: PHCS PPO |
$3,008.60
|
| Rate for Payer: Three Rivers PPO |
$2,302.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,026.20
|
| Rate for Payer: United Healthcare Commercial |
$2,670.90
|
| Rate for Payer: United Healthcare Medicare |
$2,026.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,916.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,916.50
|
|
|
HC CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$136.32
|
| Rate for Payer: Altius Commercial |
$136.32
|
| Rate for Payer: Beech Street Commercial |
$139.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.74
|
| Rate for Payer: Cigna of WY Commercial |
$139.16
|
| Rate for Payer: Entrust Commercial |
$134.90
|
| Rate for Payer: First Choice Health Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.72
|
| Rate for Payer: HealthUtah PPO |
$142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.74
|
| Rate for Payer: Multiplan Medicare/VA |
$89.03
|
| Rate for Payer: One Health Plan of WY PPO |
$139.16
|
| Rate for Payer: PacificSource Commercial |
$127.80
|
| Rate for Payer: PHCS PPO |
$139.16
|
| Rate for Payer: Three Rivers PPO |
$106.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.72
|
| Rate for Payer: United Healthcare Commercial |
$123.54
|
| Rate for Payer: United Healthcare Medicare |
$93.72
|
| Rate for Payer: WINHealth Partners Commercial |
$134.90
|
| Rate for Payer: Wise Provider Network Commercial |
$134.90
|
|
|
HC CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.16
|
| Rate for Payer: Aetna of WY Medicare |
$93.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$136.32
|
| Rate for Payer: Altius Commercial |
$136.32
|
| Rate for Payer: Beech Street Commercial |
$139.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.74
|
| Rate for Payer: Cigna of WY Commercial |
$139.16
|
| Rate for Payer: Entrust Commercial |
$134.90
|
| Rate for Payer: First Choice Health Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.36
|
| Rate for Payer: HealthUtah PPO |
$142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.74
|
| Rate for Payer: Multiplan Medicare/VA |
$78.24
|
| Rate for Payer: One Health Plan of WY PPO |
$139.16
|
| Rate for Payer: PacificSource Commercial |
$127.80
|
| Rate for Payer: PHCS PPO |
$139.16
|
| Rate for Payer: Three Rivers PPO |
$106.50
|
| Rate for Payer: TriWest Veterans Administration |
$82.36
|
| Rate for Payer: United Healthcare Commercial |
$123.54
|
| Rate for Payer: United Healthcare Medicare |
$82.36
|
| Rate for Payer: WINHealth Partners Commercial |
$139.16
|
| Rate for Payer: Wise Provider Network Commercial |
$134.90
|
|
|
HC CAUTERY CERVIX ELECTRO/THERMAL
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
5105751001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Aetna of WY Medicare |
$265.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.16
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$221.50
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$233.16
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$233.16
|
| Rate for Payer: WINHealth Partners Commercial |
$393.96
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC CAUTERY CERVIX ELECTRO/THERMAL
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
5105751001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.32
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$252.05
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$265.32
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$265.32
|
| Rate for Payer: WINHealth Partners Commercial |
$381.90
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC C DIFF AMPLIFIED PROBE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| 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 C DIFF AMPLIFIED PROBE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| 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 DIFF AMPLIFIED PROBE - TOXIN A & B GENE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC C DIFF AMPLIFIED PROBE - TOXIN A & B GENE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| 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 CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| 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 CELL MARKER STUDY
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$663.46
|
| Rate for Payer: Aetna of WY Medicare |
$446.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$649.92
|
| Rate for Payer: Altius Commercial |
$649.92
|
| Rate for Payer: Beech Street Commercial |
$663.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.82
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$656.69
|
| Rate for Payer: Cigna of WY Commercial |
$663.46
|
| Rate for Payer: Entrust Commercial |
$643.15
|
| Rate for Payer: First Choice Health Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$392.66
|
| Rate for Payer: HealthUtah PPO |
$677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$656.69
|
| Rate for Payer: Multiplan Medicare/VA |
$373.03
|
| Rate for Payer: One Health Plan of WY PPO |
$663.46
|
| Rate for Payer: PacificSource Commercial |
$609.30
|
| Rate for Payer: PHCS PPO |
$663.46
|
| Rate for Payer: Three Rivers PPO |
$507.75
|
| Rate for Payer: TriWest Veterans Administration |
$392.66
|
| Rate for Payer: United Healthcare Commercial |
$588.99
|
| Rate for Payer: United Healthcare Medicare |
$392.66
|
| Rate for Payer: WINHealth Partners Commercial |
$663.46
|
| Rate for Payer: Wise Provider Network Commercial |
$643.15
|
|
|
HC CELL MARKER STUDY
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$424.48 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$663.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$649.92
|
| Rate for Payer: Altius Commercial |
$649.92
|
| Rate for Payer: Beech Street Commercial |
$663.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.82
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$656.69
|
| Rate for Payer: Cigna of WY Commercial |
$663.46
|
| Rate for Payer: Entrust Commercial |
$643.15
|
| Rate for Payer: First Choice Health Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$446.82
|
| Rate for Payer: HealthUtah PPO |
$677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$656.69
|
| Rate for Payer: Multiplan Medicare/VA |
$424.48
|
| Rate for Payer: One Health Plan of WY PPO |
$663.46
|
| Rate for Payer: PacificSource Commercial |
$609.30
|
| Rate for Payer: PHCS PPO |
$663.46
|
| Rate for Payer: Three Rivers PPO |
$507.75
|
| Rate for Payer: TriWest Veterans Administration |
$446.82
|
| Rate for Payer: United Healthcare Commercial |
$588.99
|
| Rate for Payer: United Healthcare Medicare |
$446.82
|
| Rate for Payer: WINHealth Partners Commercial |
$643.15
|
| Rate for Payer: Wise Provider Network Commercial |
$643.15
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,755.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,900.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,300.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,800.00
|
| Rate for Payer: Altius Commercial |
$4,800.00
|
| Rate for Payer: Beech Street Commercial |
$4,900.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,105.00
|
| Rate for Payer: Cash Price |
$3,500.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,850.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,900.00
|
| Rate for Payer: Entrust Commercial |
$4,750.00
|
| Rate for Payer: First Choice Health Commercial |
$4,750.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,750.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,900.00
|
| Rate for Payer: HealthUtah PPO |
$5,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,850.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,755.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4,900.00
|
| Rate for Payer: PacificSource Commercial |
$4,500.00
|
| Rate for Payer: PHCS PPO |
$4,900.00
|
| Rate for Payer: Three Rivers PPO |
$3,750.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,900.00
|
| Rate for Payer: United Healthcare Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare Medicare |
$2,900.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,750.00
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,135.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,900.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,800.00
|
| Rate for Payer: Altius Commercial |
$4,800.00
|
| Rate for Payer: Beech Street Commercial |
$4,900.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,105.00
|
| Rate for Payer: Cash Price |
$3,500.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,850.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,900.00
|
| Rate for Payer: Entrust Commercial |
$4,750.00
|
| Rate for Payer: First Choice Health Commercial |
$4,750.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,750.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,300.00
|
| Rate for Payer: HealthUtah PPO |
$5,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,850.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4,900.00
|
| Rate for Payer: PacificSource Commercial |
$4,500.00
|
| Rate for Payer: PHCS PPO |
$4,900.00
|
| Rate for Payer: Three Rivers PPO |
$3,750.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,300.00
|
| Rate for Payer: United Healthcare Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare Medicare |
$3,300.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,750.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,750.00
|
|
|
HC CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| 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 CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| 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 CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7615170501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.35 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$640.92
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$563.50
|
| Rate for Payer: Aetna of WY Medicare |
$431.64
|
| Rate for Payer: Aetna of WY Medicare |
$379.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$627.84
|
| Rate for Payer: Altius Commercial |
$627.84
|
| Rate for Payer: Altius Commercial |
$552.00
|
| Rate for Payer: Beech Street Commercial |
$563.50
|
| Rate for Payer: Beech Street Commercial |
$640.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$536.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.08
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$634.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$557.75
|
| Rate for Payer: Cigna of WY Commercial |
$563.50
|
| Rate for Payer: Cigna of WY Commercial |
$640.92
|
| Rate for Payer: Entrust Commercial |
$621.30
|
| Rate for Payer: Entrust Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$621.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$621.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$333.50
|
| Rate for Payer: HealthUtah PPO |
$575.00
|
| Rate for Payer: HealthUtah PPO |
$654.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$557.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$634.38
|
| Rate for Payer: Multiplan Medicare/VA |
$360.35
|
| Rate for Payer: Multiplan Medicare/VA |
$316.82
|
| Rate for Payer: One Health Plan of WY PPO |
$563.50
|
| Rate for Payer: One Health Plan of WY PPO |
$640.92
|
| Rate for Payer: PacificSource Commercial |
$588.60
|
| Rate for Payer: PacificSource Commercial |
$517.50
|
| Rate for Payer: PHCS PPO |
$563.50
|
| Rate for Payer: PHCS PPO |
$640.92
|
| Rate for Payer: Three Rivers PPO |
$431.25
|
| Rate for Payer: Three Rivers PPO |
$490.50
|
| Rate for Payer: TriWest Veterans Administration |
$379.32
|
| Rate for Payer: TriWest Veterans Administration |
$333.50
|
| Rate for Payer: United Healthcare Commercial |
$500.25
|
| Rate for Payer: United Healthcare Commercial |
$568.98
|
| Rate for Payer: United Healthcare Medicare |
$379.32
|
| Rate for Payer: United Healthcare Medicare |
$333.50
|
| Rate for Payer: WINHealth Partners Commercial |
$563.50
|
| Rate for Payer: WINHealth Partners Commercial |
$640.92
|
| Rate for Payer: Wise Provider Network Commercial |
$546.25
|
| Rate for Payer: Wise Provider Network Commercial |
$621.30
|
|
|
HC CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7615170501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.06 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$640.92
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$563.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$627.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.00
|
| Rate for Payer: Altius Commercial |
$552.00
|
| Rate for Payer: Altius Commercial |
$627.84
|
| Rate for Payer: Beech Street Commercial |
$640.92
|
| Rate for Payer: Beech Street Commercial |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$536.93
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$557.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$634.38
|
| Rate for Payer: Cigna of WY Commercial |
$640.92
|
| Rate for Payer: Cigna of WY Commercial |
$563.50
|
| Rate for Payer: Entrust Commercial |
$546.25
|
| Rate for Payer: Entrust Commercial |
$621.30
|
| Rate for Payer: First Choice Health Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$621.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$621.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.50
|
| Rate for Payer: HealthUtah PPO |
$654.00
|
| Rate for Payer: HealthUtah PPO |
$575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$557.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$634.38
|
| Rate for Payer: Multiplan Medicare/VA |
$410.06
|
| Rate for Payer: Multiplan Medicare/VA |
$360.52
|
| Rate for Payer: One Health Plan of WY PPO |
$640.92
|
| Rate for Payer: One Health Plan of WY PPO |
$563.50
|
| Rate for Payer: PacificSource Commercial |
$588.60
|
| Rate for Payer: PacificSource Commercial |
$517.50
|
| Rate for Payer: PHCS PPO |
$563.50
|
| Rate for Payer: PHCS PPO |
$640.92
|
| Rate for Payer: Three Rivers PPO |
$431.25
|
| Rate for Payer: Three Rivers PPO |
$490.50
|
| Rate for Payer: TriWest Veterans Administration |
$431.64
|
| Rate for Payer: TriWest Veterans Administration |
$379.50
|
| Rate for Payer: United Healthcare Commercial |
$500.25
|
| Rate for Payer: United Healthcare Commercial |
$568.98
|
| Rate for Payer: United Healthcare Medicare |
$431.64
|
| Rate for Payer: United Healthcare Medicare |
$379.50
|
| Rate for Payer: WINHealth Partners Commercial |
$546.25
|
| Rate for Payer: WINHealth Partners Commercial |
$621.30
|
| Rate for Payer: Wise Provider Network Commercial |
$546.25
|
| Rate for Payer: Wise Provider Network Commercial |
$621.30
|
|
|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7611725001
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
