|
HC CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$405.04 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$633.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$620.16
|
| Rate for Payer: Altius Commercial |
$620.16
|
| Rate for Payer: Beech Street Commercial |
$633.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$530.37
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$626.62
|
| Rate for Payer: Cigna of WY Commercial |
$633.08
|
| Rate for Payer: Entrust Commercial |
$613.70
|
| Rate for Payer: First Choice Health Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.36
|
| Rate for Payer: HealthUtah PPO |
$646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$626.62
|
| Rate for Payer: Multiplan Medicare/VA |
$405.04
|
| Rate for Payer: One Health Plan of WY PPO |
$633.08
|
| Rate for Payer: PacificSource Commercial |
$581.40
|
| Rate for Payer: PHCS PPO |
$633.08
|
| Rate for Payer: Three Rivers PPO |
$484.50
|
| Rate for Payer: TriWest Veterans Administration |
$426.36
|
| Rate for Payer: United Healthcare Commercial |
$562.02
|
| Rate for Payer: United Healthcare Medicare |
$426.36
|
| Rate for Payer: WINHealth Partners Commercial |
$613.70
|
| Rate for Payer: Wise Provider Network Commercial |
$613.70
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$355.95 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$633.08
|
| Rate for Payer: Aetna of WY Medicare |
$426.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$620.16
|
| Rate for Payer: Altius Commercial |
$620.16
|
| Rate for Payer: Beech Street Commercial |
$633.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$530.37
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$626.62
|
| Rate for Payer: Cigna of WY Commercial |
$633.08
|
| Rate for Payer: Entrust Commercial |
$613.70
|
| Rate for Payer: First Choice Health Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$374.68
|
| Rate for Payer: HealthUtah PPO |
$646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$626.62
|
| Rate for Payer: Multiplan Medicare/VA |
$355.95
|
| Rate for Payer: One Health Plan of WY PPO |
$633.08
|
| Rate for Payer: PacificSource Commercial |
$581.40
|
| Rate for Payer: PHCS PPO |
$633.08
|
| Rate for Payer: Three Rivers PPO |
$484.50
|
| Rate for Payer: TriWest Veterans Administration |
$374.68
|
| Rate for Payer: United Healthcare Commercial |
$562.02
|
| Rate for Payer: United Healthcare Medicare |
$374.68
|
| Rate for Payer: WINHealth Partners Commercial |
$633.08
|
| Rate for Payer: Wise Provider Network Commercial |
$613.70
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Facility
|
IP
|
$5,987.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,753.85 |
| Max. Negotiated Rate |
$5,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,867.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,747.52
|
| Rate for Payer: Altius Commercial |
$5,747.52
|
| Rate for Payer: Beech Street Commercial |
$5,867.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,915.33
|
| Rate for Payer: Cash Price |
$4,190.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,807.39
|
| Rate for Payer: Cigna of WY Commercial |
$5,867.26
|
| Rate for Payer: Entrust Commercial |
$5,687.65
|
| Rate for Payer: First Choice Health Commercial |
$5,687.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,687.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,951.42
|
| Rate for Payer: HealthUtah PPO |
$5,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,807.39
|
| Rate for Payer: Multiplan Medicare/VA |
$3,753.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5,867.26
|
| Rate for Payer: PacificSource Commercial |
$5,388.30
|
| Rate for Payer: PHCS PPO |
$5,867.26
|
| Rate for Payer: Three Rivers PPO |
$4,490.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,951.42
|
| Rate for Payer: United Healthcare Commercial |
$5,208.69
|
| Rate for Payer: United Healthcare Medicare |
$3,951.42
|
| Rate for Payer: WINHealth Partners Commercial |
$5,687.65
|
| Rate for Payer: Wise Provider Network Commercial |
$5,687.65
|
|
|
HC CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,298.84 |
| Max. Negotiated Rate |
$5,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,867.26
|
| Rate for Payer: Aetna of WY Medicare |
$3,951.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,747.52
|
| Rate for Payer: Altius Commercial |
$5,747.52
|
| Rate for Payer: Beech Street Commercial |
$5,867.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,915.33
|
| Rate for Payer: Cash Price |
$4,190.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,807.39
|
| Rate for Payer: Cigna of WY Commercial |
$5,867.26
|
| Rate for Payer: Entrust Commercial |
$5,687.65
|
| Rate for Payer: First Choice Health Commercial |
$5,687.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,687.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,472.46
|
| Rate for Payer: HealthUtah PPO |
$5,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,807.39
|
| Rate for Payer: Multiplan Medicare/VA |
$3,298.84
|
| Rate for Payer: One Health Plan of WY PPO |
$5,867.26
|
| Rate for Payer: PacificSource Commercial |
$5,388.30
|
| Rate for Payer: PHCS PPO |
$5,867.26
|
| Rate for Payer: Three Rivers PPO |
$4,490.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,472.46
|
| Rate for Payer: United Healthcare Commercial |
$5,208.69
|
| Rate for Payer: United Healthcare Medicare |
$3,472.46
|
| Rate for Payer: WINHealth Partners Commercial |
$5,867.26
|
| Rate for Payer: Wise Provider Network Commercial |
$5,687.65
|
|
|
HC CROSSMATCH IMMEDIATE SPIN TECHNIQUE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CROSSMATCH IMMEDIATE SPIN TECHNIQUE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CRYOPRECIPITATE EACH UNIT
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$681.60
|
| Rate for Payer: Altius Commercial |
$681.60
|
| Rate for Payer: Beech Street Commercial |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$582.91
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: Entrust Commercial |
$674.50
|
| Rate for Payer: First Choice Health Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.60
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$445.17
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$695.80
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$468.60
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$468.60
|
| Rate for Payer: WINHealth Partners Commercial |
$674.50
|
| Rate for Payer: Wise Provider Network Commercial |
$674.50
|
|
|
HC CRYOPRECIPITATE EACH UNIT
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Medicare |
$468.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$681.60
|
| Rate for Payer: Altius Commercial |
$681.60
|
| Rate for Payer: Beech Street Commercial |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$582.91
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: Entrust Commercial |
$674.50
|
| Rate for Payer: First Choice Health Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.80
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$391.21
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$695.80
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$411.80
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$411.80
|
| Rate for Payer: WINHealth Partners Commercial |
$695.80
|
| Rate for Payer: Wise Provider Network Commercial |
$674.50
|
|
|
HC CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
5101734001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.42
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$27.00
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.42
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$28.42
|
| Rate for Payer: WINHealth Partners Commercial |
$48.02
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
5101734001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.34
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$30.72
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.34
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$32.34
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC C-SECTION PROCEDURE
|
Facility
|
IP
|
$830.00
|
|
| Hospital Charge Code |
3600000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$520.41 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$547.80
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$520.41
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$547.80
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$547.80
|
| Rate for Payer: WINHealth Partners Commercial |
$788.50
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC C-SECTION PROCEDURE
|
Facility
|
OP
|
$830.00
|
|
| Hospital Charge Code |
3600000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.33 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Aetna of WY Medicare |
$547.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.40
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.33
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.40
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$481.40
|
| Rate for Payer: WINHealth Partners Commercial |
$813.40
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,335.51 |
| Max. Negotiated Rate |
$2,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,087.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,044.80
|
| Rate for Payer: Altius Commercial |
$2,044.80
|
| Rate for Payer: Beech Street Commercial |
$2,087.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,748.73
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,066.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,087.40
|
| Rate for Payer: Entrust Commercial |
$2,023.50
|
| Rate for Payer: First Choice Health Commercial |
$2,023.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,023.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,405.80
|
| Rate for Payer: HealthUtah PPO |
$2,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,066.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,335.51
|
| Rate for Payer: One Health Plan of WY PPO |
$2,087.40
|
| Rate for Payer: PacificSource Commercial |
$1,917.00
|
| Rate for Payer: PHCS PPO |
$2,087.40
|
| Rate for Payer: Three Rivers PPO |
$1,597.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,405.80
|
| Rate for Payer: United Healthcare Commercial |
$1,853.10
|
| Rate for Payer: United Healthcare Medicare |
$1,405.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,023.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,023.50
|
|
|
HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,173.63 |
| Max. Negotiated Rate |
$2,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,087.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,405.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,044.80
|
| Rate for Payer: Altius Commercial |
$2,044.80
|
| Rate for Payer: Beech Street Commercial |
$2,087.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,748.73
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,066.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,087.40
|
| Rate for Payer: Entrust Commercial |
$2,023.50
|
| Rate for Payer: First Choice Health Commercial |
$2,023.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,023.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,235.40
|
| Rate for Payer: HealthUtah PPO |
$2,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,066.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,173.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,087.40
|
| Rate for Payer: PacificSource Commercial |
$1,917.00
|
| Rate for Payer: PHCS PPO |
$2,087.40
|
| Rate for Payer: Three Rivers PPO |
$1,597.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,235.40
|
| Rate for Payer: United Healthcare Commercial |
$1,853.10
|
| Rate for Payer: United Healthcare Medicare |
$1,235.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,087.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,023.50
|
|
|
HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,128.60 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,188.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,128.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,188.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,710.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,188.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$991.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,377.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,650.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,377.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,450.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,567.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,650.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,375.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
|
OP
|
$5,720.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,151.72 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,605.60
|
| Rate for Payer: Aetna of WY Medicare |
$3,775.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,491.20
|
| Rate for Payer: Altius Commercial |
$5,491.20
|
| Rate for Payer: Beech Street Commercial |
$5,605.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,696.12
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,548.40
|
| Rate for Payer: Cigna of WY Commercial |
$5,605.60
|
| Rate for Payer: Entrust Commercial |
$5,434.00
|
| Rate for Payer: First Choice Health Commercial |
$5,434.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,434.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,317.60
|
| Rate for Payer: HealthUtah PPO |
$5,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,548.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3,151.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,605.60
|
| Rate for Payer: PacificSource Commercial |
$5,148.00
|
| Rate for Payer: PHCS PPO |
$5,605.60
|
| Rate for Payer: Three Rivers PPO |
$4,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,317.60
|
| Rate for Payer: United Healthcare Commercial |
$4,976.40
|
| Rate for Payer: United Healthcare Medicare |
$3,317.60
|
| Rate for Payer: WINHealth Partners Commercial |
$5,605.60
|
| Rate for Payer: Wise Provider Network Commercial |
$5,434.00
|
|
|
HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
|
IP
|
$5,720.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,586.44 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,605.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,491.20
|
| Rate for Payer: Altius Commercial |
$5,491.20
|
| Rate for Payer: Beech Street Commercial |
$5,605.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,696.12
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,548.40
|
| Rate for Payer: Cigna of WY Commercial |
$5,605.60
|
| Rate for Payer: Entrust Commercial |
$5,434.00
|
| Rate for Payer: First Choice Health Commercial |
$5,434.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,434.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,775.20
|
| Rate for Payer: HealthUtah PPO |
$5,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,548.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3,586.44
|
| Rate for Payer: One Health Plan of WY PPO |
$5,605.60
|
| Rate for Payer: PacificSource Commercial |
$5,148.00
|
| Rate for Payer: PHCS PPO |
$5,605.60
|
| Rate for Payer: Three Rivers PPO |
$4,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,775.20
|
| Rate for Payer: United Healthcare Commercial |
$4,976.40
|
| Rate for Payer: United Healthcare Medicare |
$3,775.20
|
| Rate for Payer: WINHealth Partners Commercial |
$5,434.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,434.00
|
|
|
HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
HCPCS 74176
|
| Hospital Charge Code |
3527417601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,834.90 |
| Max. Negotiated Rate |
$5,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,042.10
|
| Rate for Payer: Aetna of WY Medicare |
$3,395.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,939.20
|
| Rate for Payer: Altius Commercial |
$4,939.20
|
| Rate for Payer: Beech Street Commercial |
$5,042.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,224.04
|
| Rate for Payer: Cash Price |
$3,601.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,990.65
|
| Rate for Payer: Cigna of WY Commercial |
$5,042.10
|
| Rate for Payer: Entrust Commercial |
$4,887.75
|
| Rate for Payer: First Choice Health Commercial |
$4,887.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,887.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,984.10
|
| Rate for Payer: HealthUtah PPO |
$5,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,990.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,834.90
|
| Rate for Payer: One Health Plan of WY PPO |
$5,042.10
|
| Rate for Payer: PacificSource Commercial |
$4,630.50
|
| Rate for Payer: PHCS PPO |
$5,042.10
|
| Rate for Payer: Three Rivers PPO |
$3,858.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,984.10
|
| Rate for Payer: United Healthcare Commercial |
$4,476.15
|
| Rate for Payer: United Healthcare Medicare |
$2,984.10
|
| Rate for Payer: WINHealth Partners Commercial |
$5,042.10
|
| Rate for Payer: Wise Provider Network Commercial |
$4,887.75
|
|
|
HC CT ABD & PELVIS W/O CONTRAST - CT ABDOMEN PELVIS WO CONTRAST
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
HCPCS 74176
|
| Hospital Charge Code |
3527417601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,225.92 |
| Max. Negotiated Rate |
$5,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,042.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,939.20
|
| Rate for Payer: Altius Commercial |
$4,939.20
|
| Rate for Payer: Beech Street Commercial |
$5,042.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,224.04
|
| Rate for Payer: Cash Price |
$3,601.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,990.65
|
| Rate for Payer: Cigna of WY Commercial |
$5,042.10
|
| Rate for Payer: Entrust Commercial |
$4,887.75
|
| Rate for Payer: First Choice Health Commercial |
$4,887.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,887.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,395.70
|
| Rate for Payer: HealthUtah PPO |
$5,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,990.65
|
| Rate for Payer: Multiplan Medicare/VA |
$3,225.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,042.10
|
| Rate for Payer: PacificSource Commercial |
$4,630.50
|
| Rate for Payer: PHCS PPO |
$5,042.10
|
| Rate for Payer: Three Rivers PPO |
$3,858.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,395.70
|
| Rate for Payer: United Healthcare Commercial |
$4,476.15
|
| Rate for Payer: United Healthcare Medicare |
$3,395.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,887.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,887.75
|
|
|
HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 74177
|
| Hospital Charge Code |
3527417701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,025.28 |
| Max. Negotiated Rate |
$4,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,728.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,632.00
|
| Rate for Payer: Altius Commercial |
$4,632.00
|
| Rate for Payer: Beech Street Commercial |
$4,728.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,961.32
|
| Rate for Payer: Cash Price |
$3,377.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,680.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,728.50
|
| Rate for Payer: Entrust Commercial |
$4,583.75
|
| Rate for Payer: First Choice Health Commercial |
$4,583.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,583.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,184.50
|
| Rate for Payer: HealthUtah PPO |
$4,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,680.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,025.28
|
| Rate for Payer: One Health Plan of WY PPO |
$4,728.50
|
| Rate for Payer: PacificSource Commercial |
$4,342.50
|
| Rate for Payer: PHCS PPO |
$4,728.50
|
| Rate for Payer: Three Rivers PPO |
$3,618.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,184.50
|
| Rate for Payer: United Healthcare Commercial |
$4,197.75
|
| Rate for Payer: United Healthcare Medicare |
$3,184.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,583.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,583.75
|
|
|
HC CT ABD & PELV W/CONTRAST - CT ABDOMEN PELVIS W CONTRAST
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 74177
|
| Hospital Charge Code |
3527417701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,658.58 |
| Max. Negotiated Rate |
$4,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,728.50
|
| Rate for Payer: Aetna of WY Medicare |
$3,184.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,632.00
|
| Rate for Payer: Altius Commercial |
$4,632.00
|
| Rate for Payer: Beech Street Commercial |
$4,728.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,961.32
|
| Rate for Payer: Cash Price |
$3,377.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,680.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,728.50
|
| Rate for Payer: Entrust Commercial |
$4,583.75
|
| Rate for Payer: First Choice Health Commercial |
$4,583.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,583.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,798.50
|
| Rate for Payer: HealthUtah PPO |
$4,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,680.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,658.58
|
| Rate for Payer: One Health Plan of WY PPO |
$4,728.50
|
| Rate for Payer: PacificSource Commercial |
$4,342.50
|
| Rate for Payer: PHCS PPO |
$4,728.50
|
| Rate for Payer: Three Rivers PPO |
$3,618.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,798.50
|
| Rate for Payer: United Healthcare Commercial |
$4,197.75
|
| Rate for Payer: United Healthcare Medicare |
$2,798.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,728.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,583.75
|
|
|
HC CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN
|
Facility
|
IP
|
$3,985.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
3527563501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,498.60 |
| Max. Negotiated Rate |
$3,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,905.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,825.60
|
| Rate for Payer: Altius Commercial |
$3,825.60
|
| Rate for Payer: Beech Street Commercial |
$3,905.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,271.68
|
| Rate for Payer: Cash Price |
$2,789.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,865.45
|
| Rate for Payer: Cigna of WY Commercial |
$3,905.30
|
| Rate for Payer: Entrust Commercial |
$3,785.75
|
| Rate for Payer: First Choice Health Commercial |
$3,785.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,785.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,630.10
|
| Rate for Payer: HealthUtah PPO |
$3,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,865.45
|
| Rate for Payer: Multiplan Medicare/VA |
$2,498.60
|
| Rate for Payer: One Health Plan of WY PPO |
$3,905.30
|
| Rate for Payer: PacificSource Commercial |
$3,586.50
|
| Rate for Payer: PHCS PPO |
$3,905.30
|
| Rate for Payer: Three Rivers PPO |
$2,988.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,630.10
|
| Rate for Payer: United Healthcare Commercial |
$3,466.95
|
| Rate for Payer: United Healthcare Medicare |
$2,630.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,785.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,785.75
|
|
