|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7611725001
|
|
Hospital Revenue Code
|
761
|
| 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 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.39 |
| 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: 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 |
$21.46
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$21.46
|
| Rate for Payer: WINHealth Partners Commercial |
$36.26
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| 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 CHEMILUMINESCENT ASSAY
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$240.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$201.12
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.70
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$211.70
|
| Rate for Payer: WINHealth Partners Commercial |
$357.70
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC CHEMILUMINESCENT ASSAY
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.90
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$228.86
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.90
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$240.90
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC CHEMILUMINESCENT ASSAY - CERTOLIZUMAB ANTIBODY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMILUMINESCENT ASSAY - CERTOLIZUMAB ANTIBODY
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMILUMINESCENT ASSAY - IGF BNDING PROTEIN 3
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMILUMINESCENT ASSAY - IGF BNDING PROTEIN 3
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMILUMINESCENT ASSAY - LEPTIN
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC CHEMILUMINESCENT ASSAY - LEPTIN
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC CHEMILUMINESCENT ASSAY - PARATHYROID HRM RELPEPTID
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMILUMINESCENT ASSAY - PARATHYROID HRM RELPEPTID
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMISTRY TESTS
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
3010000001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Aetna of WY Medicare |
$15.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.92
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.22
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: WINHealth Partners Commercial |
$23.52
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
|
|
HC CHEMISTRY TESTS
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
3010000001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.84
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Multiplan Medicare/VA |
$15.05
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: TriWest Veterans Administration |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicare |
$15.84
|
| Rate for Payer: WINHealth Partners Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
|
|
HC CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
5106461601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$398.77 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$610.56
|
| Rate for Payer: Altius Commercial |
$610.56
|
| Rate for Payer: Beech Street Commercial |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$522.16
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: Entrust Commercial |
$604.20
|
| Rate for Payer: First Choice Health Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$419.76
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$398.77
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$623.28
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$419.76
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$419.76
|
| Rate for Payer: WINHealth Partners Commercial |
$604.20
|
| Rate for Payer: Wise Provider Network Commercial |
$604.20
|
|
|
HC CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
5106461601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$350.44 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$419.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$610.56
|
| Rate for Payer: Altius Commercial |
$610.56
|
| Rate for Payer: Beech Street Commercial |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$522.16
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: Entrust Commercial |
$604.20
|
| Rate for Payer: First Choice Health Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$368.88
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$350.44
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$623.28
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$368.88
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$368.88
|
| Rate for Payer: WINHealth Partners Commercial |
$623.28
|
| Rate for Payer: Wise Provider Network Commercial |
$604.20
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$346.58 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$415.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.84
|
| Rate for Payer: Altius Commercial |
$603.84
|
| Rate for Payer: Beech Street Commercial |
$616.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.41
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: Entrust Commercial |
$597.55
|
| Rate for Payer: First Choice Health Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$364.82
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$346.58
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$616.42
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$364.82
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Medicare |
$364.82
|
| Rate for Payer: WINHealth Partners Commercial |
$616.42
|
| Rate for Payer: Wise Provider Network Commercial |
$597.55
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$394.38 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.84
|
| Rate for Payer: Altius Commercial |
$603.84
|
| Rate for Payer: Beech Street Commercial |
$616.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.41
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: Entrust Commercial |
$597.55
|
| Rate for Payer: First Choice Health Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.14
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$394.38
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$616.42
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$415.14
|
| Rate for Payer: United Healthcare Commercial |
$547.23
|
| Rate for Payer: United Healthcare Medicare |
$415.14
|
| Rate for Payer: WINHealth Partners Commercial |
$597.55
|
| Rate for Payer: Wise Provider Network Commercial |
$597.55
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
3359644601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$371.92 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$661.50
|
| Rate for Payer: Aetna of WY Medicare |
$445.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$648.00
|
| Rate for Payer: Altius Commercial |
$648.00
|
| Rate for Payer: Beech Street Commercial |
$661.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$554.18
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$654.75
|
| Rate for Payer: Cigna of WY Commercial |
$661.50
|
| Rate for Payer: Entrust Commercial |
$641.25
|
| Rate for Payer: First Choice Health Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$391.50
|
| Rate for Payer: HealthUtah PPO |
$675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$654.75
|
| Rate for Payer: Multiplan Medicare/VA |
$371.92
|
| Rate for Payer: One Health Plan of WY PPO |
$661.50
|
| Rate for Payer: PacificSource Commercial |
$607.50
|
| Rate for Payer: PHCS PPO |
$661.50
|
| Rate for Payer: Three Rivers PPO |
$506.25
|
| Rate for Payer: TriWest Veterans Administration |
$391.50
|
| Rate for Payer: United Healthcare Commercial |
$587.25
|
| Rate for Payer: United Healthcare Medicare |
$391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$661.50
|
| Rate for Payer: Wise Provider Network Commercial |
$641.25
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
3359644601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$423.22 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$661.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$648.00
|
| Rate for Payer: Altius Commercial |
$648.00
|
| Rate for Payer: Beech Street Commercial |
$661.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$554.18
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$654.75
|
| Rate for Payer: Cigna of WY Commercial |
$661.50
|
| Rate for Payer: Entrust Commercial |
$641.25
|
| Rate for Payer: First Choice Health Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.50
|
| Rate for Payer: HealthUtah PPO |
$675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$654.75
|
| Rate for Payer: Multiplan Medicare/VA |
$423.22
|
| Rate for Payer: One Health Plan of WY PPO |
$661.50
|
| Rate for Payer: PacificSource Commercial |
$607.50
|
| Rate for Payer: PHCS PPO |
$661.50
|
| Rate for Payer: Three Rivers PPO |
$506.25
|
| Rate for Payer: TriWest Veterans Administration |
$445.50
|
| Rate for Payer: United Healthcare Commercial |
$587.25
|
| Rate for Payer: United Healthcare Medicare |
$445.50
|
| Rate for Payer: WINHealth Partners Commercial |
$641.25
|
| Rate for Payer: Wise Provider Network Commercial |
$641.25
|
|
|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$190.10 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.10
|
| Rate for Payer: Aetna of WY Medicare |
$227.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$331.20
|
| Rate for Payer: Altius Commercial |
$331.20
|
| Rate for Payer: Beech Street Commercial |
$338.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$334.65
|
| Rate for Payer: Cigna of WY Commercial |
$338.10
|
| Rate for Payer: Entrust Commercial |
$327.75
|
| Rate for Payer: First Choice Health Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.10
|
| Rate for Payer: HealthUtah PPO |
$345.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$334.65
|
| Rate for Payer: Multiplan Medicare/VA |
$190.10
|
| Rate for Payer: One Health Plan of WY PPO |
$338.10
|
| Rate for Payer: PacificSource Commercial |
$310.50
|
| Rate for Payer: PHCS PPO |
$338.10
|
| Rate for Payer: Three Rivers PPO |
$258.75
|
| Rate for Payer: TriWest Veterans Administration |
$200.10
|
| Rate for Payer: United Healthcare Commercial |
$300.15
|
| Rate for Payer: United Healthcare Medicare |
$200.10
|
| Rate for Payer: WINHealth Partners Commercial |
$338.10
|
| Rate for Payer: Wise Provider Network Commercial |
$327.75
|
|
|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$338.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$331.20
|
| Rate for Payer: Altius Commercial |
$331.20
|
| Rate for Payer: Beech Street Commercial |
$338.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$334.65
|
| Rate for Payer: Cigna of WY Commercial |
$338.10
|
| Rate for Payer: Entrust Commercial |
$327.75
|
| Rate for Payer: First Choice Health Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$327.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.70
|
| Rate for Payer: HealthUtah PPO |
$345.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$334.65
|
| Rate for Payer: Multiplan Medicare/VA |
$216.32
|
| Rate for Payer: One Health Plan of WY PPO |
$338.10
|
| Rate for Payer: PacificSource Commercial |
$310.50
|
| Rate for Payer: PHCS PPO |
$338.10
|
| Rate for Payer: Three Rivers PPO |
$258.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.70
|
| Rate for Payer: United Healthcare Commercial |
$300.15
|
| Rate for Payer: United Healthcare Medicare |
$227.70
|
| Rate for Payer: WINHealth Partners Commercial |
$327.75
|
| Rate for Payer: Wise Provider Network Commercial |
$327.75
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.70
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$279.02
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$293.70
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$293.70
|
| Rate for Payer: WINHealth Partners Commercial |
$422.75
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$293.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.10
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$245.20
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$258.10
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$258.10
|
| Rate for Payer: WINHealth Partners Commercial |
$436.10
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
