|
HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3507701205
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,504.80 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,352.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,304.00
|
| Rate for Payer: Altius Commercial |
$2,304.00
|
| Rate for Payer: Beech Street Commercial |
$2,352.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,970.40
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,328.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,352.00
|
| Rate for Payer: Entrust Commercial |
$2,280.00
|
| Rate for Payer: First Choice Health Commercial |
$2,280.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,280.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,584.00
|
| Rate for Payer: HealthUtah PPO |
$2,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,328.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,504.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,352.00
|
| Rate for Payer: PacificSource Commercial |
$2,160.00
|
| Rate for Payer: PHCS PPO |
$2,352.00
|
| Rate for Payer: Three Rivers PPO |
$1,800.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,584.00
|
| Rate for Payer: United Healthcare Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare Medicare |
$1,584.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,280.00
|
|
|
HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3507701205
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,322.40 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,352.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,584.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,304.00
|
| Rate for Payer: Altius Commercial |
$2,304.00
|
| Rate for Payer: Beech Street Commercial |
$2,352.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,970.40
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,328.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,352.00
|
| Rate for Payer: Entrust Commercial |
$2,280.00
|
| Rate for Payer: First Choice Health Commercial |
$2,280.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,280.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,392.00
|
| Rate for Payer: HealthUtah PPO |
$2,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,328.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,322.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,352.00
|
| Rate for Payer: PacificSource Commercial |
$2,160.00
|
| Rate for Payer: PHCS PPO |
$2,352.00
|
| Rate for Payer: Three Rivers PPO |
$1,800.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,392.00
|
| Rate for Payer: United Healthcare Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare Medicare |
$1,392.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,352.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,280.00
|
|
|
HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3527557101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3527557101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
3517049201
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,113.02 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,979.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,939.20
|
| Rate for Payer: Altius Commercial |
$1,939.20
|
| Rate for Payer: Beech Street Commercial |
$1,979.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,959.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,979.60
|
| Rate for Payer: Entrust Commercial |
$1,919.00
|
| Rate for Payer: First Choice Health Commercial |
$1,919.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,919.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,171.60
|
| Rate for Payer: HealthUtah PPO |
$2,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,959.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,113.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,979.60
|
| Rate for Payer: PacificSource Commercial |
$1,818.00
|
| Rate for Payer: PHCS PPO |
$1,979.60
|
| Rate for Payer: Three Rivers PPO |
$1,515.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,171.60
|
| Rate for Payer: United Healthcare Commercial |
$1,757.40
|
| Rate for Payer: United Healthcare Medicare |
$1,171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,979.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,919.00
|
|
|
HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
3517049201
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,266.54 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,979.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,939.20
|
| Rate for Payer: Altius Commercial |
$1,939.20
|
| Rate for Payer: Beech Street Commercial |
$1,979.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,414.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,959.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,979.60
|
| Rate for Payer: Entrust Commercial |
$1,919.00
|
| Rate for Payer: First Choice Health Commercial |
$1,919.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,919.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,333.20
|
| Rate for Payer: HealthUtah PPO |
$2,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,959.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,266.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,979.60
|
| Rate for Payer: PacificSource Commercial |
$1,818.00
|
| Rate for Payer: PHCS PPO |
$1,979.60
|
| Rate for Payer: Three Rivers PPO |
$1,515.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,333.20
|
| Rate for Payer: United Healthcare Commercial |
$1,757.40
|
| Rate for Payer: United Healthcare Medicare |
$1,333.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,919.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,919.00
|
|
|
HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST
|
Facility
|
IP
|
$2,680.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
3517049101
|
|
Hospital Revenue Code
|
351
|
| 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 NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST
|
Facility
|
OP
|
$2,680.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
3517049101
|
|
Hospital Revenue Code
|
351
|
| 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 PATELLAR FX W/O MANIPULATIO
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
5102752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.16 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Aetna of WY Medicare |
$202.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.72
|
| Rate for Payer: Altius Commercial |
$294.72
|
| Rate for Payer: Beech Street Commercial |
$300.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.79
|
| Rate for Payer: Cigna of WY Commercial |
$300.86
|
| Rate for Payer: Entrust Commercial |
$291.65
|
| Rate for Payer: First Choice Health Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.06
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$169.16
|
| Rate for Payer: One Health Plan of WY PPO |
$300.86
|
| Rate for Payer: PacificSource Commercial |
$276.30
|
| Rate for Payer: PHCS PPO |
$300.86
|
| Rate for Payer: Three Rivers PPO |
$230.25
|
| Rate for Payer: TriWest Veterans Administration |
$178.06
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$178.06
|
| Rate for Payer: WINHealth Partners Commercial |
$300.86
|
| Rate for Payer: Wise Provider Network Commercial |
$291.65
|
|
|
HC CT PATELLAR FX W/O MANIPULATIO
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
5102752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.49 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.72
|
| Rate for Payer: Altius Commercial |
$294.72
|
| Rate for Payer: Beech Street Commercial |
$300.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.79
|
| Rate for Payer: Cigna of WY Commercial |
$300.86
|
| Rate for Payer: Entrust Commercial |
$291.65
|
| Rate for Payer: First Choice Health Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.62
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$192.49
|
| Rate for Payer: One Health Plan of WY PPO |
$300.86
|
| Rate for Payer: PacificSource Commercial |
$276.30
|
| Rate for Payer: PHCS PPO |
$300.86
|
| Rate for Payer: Three Rivers PPO |
$230.25
|
| Rate for Payer: TriWest Veterans Administration |
$202.62
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$202.62
|
| Rate for Payer: WINHealth Partners Commercial |
$291.65
|
| Rate for Payer: Wise Provider Network Commercial |
$291.65
|
|
|
HC CT PERCUT BX, LUNG/MEDIASTINUM RIGHT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
3203240501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,254.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC CT PERCUT BX, LUNG/MEDIASTINUM RIGHT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
3203240501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,102.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,160.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,102.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,160.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,160.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC CT PERFUSION W CONTRAST
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
3500042T01
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC CT PERFUSION W CONTRAST
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
3500042T01
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
5103090301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.54
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$105.96
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$111.54
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$111.54
|
| Rate for Payer: WINHealth Partners Commercial |
$160.55
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 30903 50
|
| Hospital Charge Code |
5103090301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.55 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$325.44
|
| Rate for Payer: Altius Commercial |
$325.44
|
| Rate for Payer: Beech Street Commercial |
$332.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.32
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.83
|
| Rate for Payer: Cigna of WY Commercial |
$332.22
|
| Rate for Payer: Entrust Commercial |
$322.05
|
| Rate for Payer: First Choice Health Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.74
|
| Rate for Payer: HealthUtah PPO |
$339.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.83
|
| Rate for Payer: Multiplan Medicare/VA |
$212.55
|
| Rate for Payer: One Health Plan of WY PPO |
$332.22
|
| Rate for Payer: PacificSource Commercial |
$305.10
|
| Rate for Payer: PHCS PPO |
$332.22
|
| Rate for Payer: Three Rivers PPO |
$254.25
|
| Rate for Payer: TriWest Veterans Administration |
$223.74
|
| Rate for Payer: United Healthcare Commercial |
$294.93
|
| Rate for Payer: United Healthcare Medicare |
$223.74
|
| Rate for Payer: WINHealth Partners Commercial |
$322.05
|
| Rate for Payer: Wise Provider Network Commercial |
$322.05
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
7613090301
|
|
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 CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
7613090301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
5103090301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Aetna of WY Medicare |
$111.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.02
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$93.12
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.02
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$98.02
|
| Rate for Payer: WINHealth Partners Commercial |
$165.62
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 30903 50
|
| Hospital Charge Code |
5103090301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.22
|
| Rate for Payer: Aetna of WY Medicare |
$223.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$325.44
|
| Rate for Payer: Altius Commercial |
$325.44
|
| Rate for Payer: Beech Street Commercial |
$332.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.32
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.83
|
| Rate for Payer: Cigna of WY Commercial |
$332.22
|
| Rate for Payer: Entrust Commercial |
$322.05
|
| Rate for Payer: First Choice Health Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.62
|
| Rate for Payer: HealthUtah PPO |
$339.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.83
|
| Rate for Payer: Multiplan Medicare/VA |
$186.79
|
| Rate for Payer: One Health Plan of WY PPO |
$332.22
|
| Rate for Payer: PacificSource Commercial |
$305.10
|
| Rate for Payer: PHCS PPO |
$332.22
|
| Rate for Payer: Three Rivers PPO |
$254.25
|
| Rate for Payer: TriWest Veterans Administration |
$196.62
|
| Rate for Payer: United Healthcare Commercial |
$294.93
|
| Rate for Payer: United Healthcare Medicare |
$196.62
|
| Rate for Payer: WINHealth Partners Commercial |
$332.22
|
| Rate for Payer: Wise Provider Network Commercial |
$322.05
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
5103090101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.22
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.06
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$63.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
5103090101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.94
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.34
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$71.94
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
5103090101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.06 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.22
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$136.06
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.22
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$143.22
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 30901 50
|
| Hospital Charge Code |
5103090101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.86
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$119.57
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$125.86
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
7613090101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
