|
HC CT ANGIO ABDOMINAL ARTERIES - CT ANGIO AORTA & BILAT ILIOFEMORAL RUN
|
Facility
|
OP
|
$3,985.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
3527563501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,195.74 |
| Max. Negotiated Rate |
$3,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,905.30
|
| Rate for Payer: Aetna of WY Medicare |
$2,630.10
|
| 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 |
$2,311.30
|
| Rate for Payer: HealthUtah PPO |
$3,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,865.45
|
| Rate for Payer: Multiplan Medicare/VA |
$2,195.74
|
| 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 |
$2,311.30
|
| Rate for Payer: United Healthcare Commercial |
$3,466.95
|
| Rate for Payer: United Healthcare Medicare |
$2,311.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,905.30
|
| Rate for Payer: Wise Provider Network Commercial |
$3,785.75
|
|
|
HC CT ANGIO ABDOM W/O & W/DYE - CT ANGIOGRAM ABDOMEN W CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
3527417501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT ANGIO ABDOM W/O & W/DYE - CT ANGIOGRAM ABDOMEN W CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
3527417501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST
|
Facility
|
OP
|
$6,590.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
3527417401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,631.09 |
| Max. Negotiated Rate |
$6,590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,458.20
|
| Rate for Payer: Aetna of WY Medicare |
$4,349.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,326.40
|
| Rate for Payer: Altius Commercial |
$6,326.40
|
| Rate for Payer: Beech Street Commercial |
$6,458.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,410.39
|
| Rate for Payer: Cash Price |
$4,613.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,392.30
|
| Rate for Payer: Cigna of WY Commercial |
$6,458.20
|
| Rate for Payer: Entrust Commercial |
$6,260.50
|
| Rate for Payer: First Choice Health Commercial |
$6,260.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,260.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,822.20
|
| Rate for Payer: HealthUtah PPO |
$6,590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,392.30
|
| Rate for Payer: Multiplan Medicare/VA |
$3,631.09
|
| Rate for Payer: One Health Plan of WY PPO |
$6,458.20
|
| Rate for Payer: PacificSource Commercial |
$5,931.00
|
| Rate for Payer: PHCS PPO |
$6,458.20
|
| Rate for Payer: Three Rivers PPO |
$4,942.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,822.20
|
| Rate for Payer: United Healthcare Commercial |
$5,733.30
|
| Rate for Payer: United Healthcare Medicare |
$3,822.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,458.20
|
| Rate for Payer: Wise Provider Network Commercial |
$6,260.50
|
|
|
HC CT ANGIO ABD&PELV W/O&W/DYE - CT ANGIOGRAM ABDOMEN PELVIS W CONTRAST
|
Facility
|
IP
|
$6,590.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
3527417401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$4,131.93 |
| Max. Negotiated Rate |
$6,590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,458.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,326.40
|
| Rate for Payer: Altius Commercial |
$6,326.40
|
| Rate for Payer: Beech Street Commercial |
$6,458.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,410.39
|
| Rate for Payer: Cash Price |
$4,613.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,392.30
|
| Rate for Payer: Cigna of WY Commercial |
$6,458.20
|
| Rate for Payer: Entrust Commercial |
$6,260.50
|
| Rate for Payer: First Choice Health Commercial |
$6,260.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,260.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,349.40
|
| Rate for Payer: HealthUtah PPO |
$6,590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,392.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4,131.93
|
| Rate for Payer: One Health Plan of WY PPO |
$6,458.20
|
| Rate for Payer: PacificSource Commercial |
$5,931.00
|
| Rate for Payer: PHCS PPO |
$6,458.20
|
| Rate for Payer: Three Rivers PPO |
$4,942.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,349.40
|
| Rate for Payer: United Healthcare Commercial |
$5,733.30
|
| Rate for Payer: United Healthcare Medicare |
$4,349.40
|
| Rate for Payer: WINHealth Partners Commercial |
$6,260.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,260.50
|
|
|
HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
3527127501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,911.97 |
| Max. Negotiated Rate |
$3,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,400.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,290.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,331.20
|
| Rate for Payer: Altius Commercial |
$3,331.20
|
| Rate for Payer: Beech Street Commercial |
$3,400.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,848.87
|
| Rate for Payer: Cash Price |
$2,429.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,365.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,400.60
|
| Rate for Payer: Entrust Commercial |
$3,296.50
|
| Rate for Payer: First Choice Health Commercial |
$3,296.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,296.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,012.60
|
| Rate for Payer: HealthUtah PPO |
$3,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,365.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,911.97
|
| Rate for Payer: One Health Plan of WY PPO |
$3,400.60
|
| Rate for Payer: PacificSource Commercial |
$3,123.00
|
| Rate for Payer: PHCS PPO |
$3,400.60
|
| Rate for Payer: Three Rivers PPO |
$2,602.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,012.60
|
| Rate for Payer: United Healthcare Commercial |
$3,018.90
|
| Rate for Payer: United Healthcare Medicare |
$2,012.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,400.60
|
| Rate for Payer: Wise Provider Network Commercial |
$3,296.50
|
|
|
HC CT ANGIO, CHEST, COMBO, INCL IMAGE - CT CHEST ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
3527127501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,175.69 |
| Max. Negotiated Rate |
$3,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,400.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,331.20
|
| Rate for Payer: Altius Commercial |
$3,331.20
|
| Rate for Payer: Beech Street Commercial |
$3,400.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,848.87
|
| Rate for Payer: Cash Price |
$2,429.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,365.90
|
| Rate for Payer: Cigna of WY Commercial |
$3,400.60
|
| Rate for Payer: Entrust Commercial |
$3,296.50
|
| Rate for Payer: First Choice Health Commercial |
$3,296.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,296.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,290.20
|
| Rate for Payer: HealthUtah PPO |
$3,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,365.90
|
| Rate for Payer: Multiplan Medicare/VA |
$2,175.69
|
| Rate for Payer: One Health Plan of WY PPO |
$3,400.60
|
| Rate for Payer: PacificSource Commercial |
$3,123.00
|
| Rate for Payer: PHCS PPO |
$3,400.60
|
| Rate for Payer: Three Rivers PPO |
$2,602.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,290.20
|
| Rate for Payer: United Healthcare Commercial |
$3,018.90
|
| Rate for Payer: United Healthcare Medicare |
$2,290.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,296.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,296.50
|
|
|
HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,015.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
3517049601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,661.26 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,989.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,894.40
|
| Rate for Payer: Altius Commercial |
$2,894.40
|
| Rate for Payer: Beech Street Commercial |
$2,954.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,475.32
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: Entrust Commercial |
$2,864.25
|
| Rate for Payer: First Choice Health Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,748.70
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,661.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,954.70
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,748.70
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$1,748.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,954.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,864.25
|
|
|
HC CT ANGIO,HEAD COMBO - CT HEAD ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,015.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
3517049601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,890.40 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,894.40
|
| Rate for Payer: Altius Commercial |
$2,894.40
|
| Rate for Payer: Beech Street Commercial |
$2,954.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,475.32
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: Entrust Commercial |
$2,864.25
|
| Rate for Payer: First Choice Health Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.90
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,890.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,954.70
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.90
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$1,989.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,864.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,864.25
|
|
|
HC CT ANGIO,HEAD COMBO - CT HEAD NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,015.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
3517049602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,661.26 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,989.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,894.40
|
| Rate for Payer: Altius Commercial |
$2,894.40
|
| Rate for Payer: Beech Street Commercial |
$2,954.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,475.32
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: Entrust Commercial |
$2,864.25
|
| Rate for Payer: First Choice Health Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,748.70
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,661.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,954.70
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,748.70
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$1,748.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,954.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,864.25
|
|
|
HC CT ANGIO,HEAD COMBO - CT HEAD NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,015.00
|
|
|
Service Code
|
HCPCS 70496
|
| Hospital Charge Code |
3517049602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,890.40 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,954.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,894.40
|
| Rate for Payer: Altius Commercial |
$2,894.40
|
| Rate for Payer: Beech Street Commercial |
$2,954.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,475.32
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,924.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,954.70
|
| Rate for Payer: Entrust Commercial |
$2,864.25
|
| Rate for Payer: First Choice Health Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,864.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.90
|
| Rate for Payer: HealthUtah PPO |
$3,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,924.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,890.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,954.70
|
| Rate for Payer: PacificSource Commercial |
$2,713.50
|
| Rate for Payer: PHCS PPO |
$2,954.70
|
| Rate for Payer: Three Rivers PPO |
$2,261.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.90
|
| Rate for Payer: United Healthcare Commercial |
$2,623.05
|
| Rate for Payer: United Healthcare Medicare |
$1,989.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,864.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,864.25
|
|
|
HC CT ANGIO HRT W/3D IMAGE - CT HEART CORONARY ANGIOGRAM
|
Facility
|
OP
|
$2,680.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
3527557401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,476.68 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,626.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,768.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,572.80
|
| Rate for Payer: Altius Commercial |
$2,572.80
|
| Rate for Payer: Beech Street Commercial |
$2,626.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,200.28
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,599.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,626.40
|
| Rate for Payer: Entrust Commercial |
$2,546.00
|
| Rate for Payer: First Choice Health Commercial |
$2,546.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,546.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,554.40
|
| Rate for Payer: HealthUtah PPO |
$2,680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,599.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,476.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,626.40
|
| Rate for Payer: PacificSource Commercial |
$2,412.00
|
| Rate for Payer: PHCS PPO |
$2,626.40
|
| Rate for Payer: Three Rivers PPO |
$2,010.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,554.40
|
| Rate for Payer: United Healthcare Commercial |
$2,331.60
|
| Rate for Payer: United Healthcare Medicare |
$1,554.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,626.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,546.00
|
|
|
HC CT ANGIO HRT W/3D IMAGE - CT HEART CORONARY ANGIOGRAM
|
Facility
|
IP
|
$2,680.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
3527557401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,680.36 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,626.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,572.80
|
| Rate for Payer: Altius Commercial |
$2,572.80
|
| Rate for Payer: Beech Street Commercial |
$2,626.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,200.28
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,599.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,626.40
|
| Rate for Payer: Entrust Commercial |
$2,546.00
|
| Rate for Payer: First Choice Health Commercial |
$2,546.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,546.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,768.80
|
| Rate for Payer: HealthUtah PPO |
$2,680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,599.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,680.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,626.40
|
| Rate for Payer: PacificSource Commercial |
$2,412.00
|
| Rate for Payer: PHCS PPO |
$2,626.40
|
| Rate for Payer: Three Rivers PPO |
$2,010.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,768.80
|
| Rate for Payer: United Healthcare Commercial |
$2,331.60
|
| Rate for Payer: United Healthcare Medicare |
$1,768.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,546.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,546.00
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT LT ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$815.10 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$858.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$815.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$858.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$858.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT LT ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$716.30 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Aetna of WY Medicare |
$858.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$754.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$716.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$754.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$754.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$716.30 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Aetna of WY Medicare |
$858.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$754.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$716.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$754.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$754.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$815.10 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$858.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$815.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$858.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$858.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,515.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
3517049801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,203.90 |
| Max. Negotiated Rate |
$3,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,444.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,374.40
|
| Rate for Payer: Altius Commercial |
$3,374.40
|
| Rate for Payer: Beech Street Commercial |
$3,444.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,885.82
|
| Rate for Payer: Cash Price |
$2,460.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,409.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,444.70
|
| Rate for Payer: Entrust Commercial |
$3,339.25
|
| Rate for Payer: First Choice Health Commercial |
$3,339.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,339.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,319.90
|
| Rate for Payer: HealthUtah PPO |
$3,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,409.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,203.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,444.70
|
| Rate for Payer: PacificSource Commercial |
$3,163.50
|
| Rate for Payer: PHCS PPO |
$3,444.70
|
| Rate for Payer: Three Rivers PPO |
$2,636.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,319.90
|
| Rate for Payer: United Healthcare Commercial |
$3,058.05
|
| Rate for Payer: United Healthcare Medicare |
$2,319.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3,339.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,339.25
|
|
|
HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,515.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
3517049801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,936.76 |
| Max. Negotiated Rate |
$3,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,444.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,319.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,374.40
|
| Rate for Payer: Altius Commercial |
$3,374.40
|
| Rate for Payer: Beech Street Commercial |
$3,444.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,885.82
|
| Rate for Payer: Cash Price |
$2,460.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,409.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,444.70
|
| Rate for Payer: Entrust Commercial |
$3,339.25
|
| Rate for Payer: First Choice Health Commercial |
$3,339.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,339.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,038.70
|
| Rate for Payer: HealthUtah PPO |
$3,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,409.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,936.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,444.70
|
| Rate for Payer: PacificSource Commercial |
$3,163.50
|
| Rate for Payer: PHCS PPO |
$3,444.70
|
| Rate for Payer: Three Rivers PPO |
$2,636.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,038.70
|
| Rate for Payer: United Healthcare Commercial |
$3,058.05
|
| Rate for Payer: United Healthcare Medicare |
$2,038.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,444.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3,339.25
|
|
|
HC CT ANGIO,UPPER EXTREM,COMBO - CT UPPER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
3527320602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,481.64 |
| Max. Negotiated Rate |
$2,689.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,635.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,774.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,581.44
|
| Rate for Payer: Altius Commercial |
$2,581.44
|
| Rate for Payer: Beech Street Commercial |
$2,635.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,207.67
|
| Rate for Payer: Cash Price |
$1,882.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,608.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,635.22
|
| Rate for Payer: Entrust Commercial |
$2,554.55
|
| Rate for Payer: First Choice Health Commercial |
$2,554.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,554.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,559.62
|
| Rate for Payer: HealthUtah PPO |
$2,689.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,608.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,481.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,635.22
|
| Rate for Payer: PacificSource Commercial |
$2,420.10
|
| Rate for Payer: PHCS PPO |
$2,635.22
|
| Rate for Payer: Three Rivers PPO |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,559.62
|
| Rate for Payer: United Healthcare Commercial |
$2,339.43
|
| Rate for Payer: United Healthcare Medicare |
$1,559.62
|
| Rate for Payer: WINHealth Partners Commercial |
$2,635.22
|
| Rate for Payer: Wise Provider Network Commercial |
$2,554.55
|
|
|
HC CT ANGIO,UPPER EXTREM,COMBO - CT UPPER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
3527320602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,686.00 |
| Max. Negotiated Rate |
$2,689.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,635.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,581.44
|
| Rate for Payer: Altius Commercial |
$2,581.44
|
| Rate for Payer: Beech Street Commercial |
$2,635.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,207.67
|
| Rate for Payer: Cash Price |
$1,882.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,608.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,635.22
|
| Rate for Payer: Entrust Commercial |
$2,554.55
|
| Rate for Payer: First Choice Health Commercial |
$2,554.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,554.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,774.74
|
| Rate for Payer: HealthUtah PPO |
$2,689.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,608.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,686.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,635.22
|
| Rate for Payer: PacificSource Commercial |
$2,420.10
|
| Rate for Payer: PHCS PPO |
$2,635.22
|
| Rate for Payer: Three Rivers PPO |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,774.74
|
| Rate for Payer: United Healthcare Commercial |
$2,339.43
|
| Rate for Payer: United Healthcare Medicare |
$1,774.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2,554.55
|
| Rate for Payer: Wise Provider Network Commercial |
$2,554.55
|
|
|
HC CT BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3505020001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC CT BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3505020001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC CT CHEST LOW DOSE LUNG CANCER SCREENING
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
3507127101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$924.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
|
HC CT CHEST LOW DOSE LUNG CANCER SCREENING
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
3507127101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$812.72 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$812.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$855.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$855.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,445.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
