|
HC DEXA BODY FAT ASSESSMENT
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC DEXA BODY FAT ASSESSMENT
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC DIAB MANAGE TRN IND/GROUP
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
942G010901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC DIAB MANAGE TRN IND/GROUP
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
942G010901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC DIAB MANAGE TRN PER INDIV
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
942G010801
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC DIAB MANAGE TRN PER INDIV
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
942G010801
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.02
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
3206232801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,708.10 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,046.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,976.00
|
| Rate for Payer: Altius Commercial |
$2,976.00
|
| Rate for Payer: Beech Street Commercial |
$3,038.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,545.10
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.00
|
| Rate for Payer: Entrust Commercial |
$2,945.00
|
| Rate for Payer: First Choice Health Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,798.00
|
| Rate for Payer: HealthUtah PPO |
$3,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,708.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.00
|
| Rate for Payer: PacificSource Commercial |
$2,790.00
|
| Rate for Payer: PHCS PPO |
$3,038.00
|
| Rate for Payer: Three Rivers PPO |
$2,325.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,798.00
|
| Rate for Payer: United Healthcare Commercial |
$2,697.00
|
| Rate for Payer: United Healthcare Medicare |
$1,798.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,038.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,945.00
|
|
|
HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
3506232801
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,275.63 |
| Max. Negotiated Rate |
$4,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,047.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,725.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,964.80
|
| Rate for Payer: Altius Commercial |
$3,964.80
|
| Rate for Payer: Beech Street Commercial |
$4,047.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,390.73
|
| Rate for Payer: Cash Price |
$2,891.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,006.10
|
| Rate for Payer: Cigna of WY Commercial |
$4,047.40
|
| Rate for Payer: Entrust Commercial |
$3,923.50
|
| Rate for Payer: First Choice Health Commercial |
$3,923.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,923.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,395.40
|
| Rate for Payer: HealthUtah PPO |
$4,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,006.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,275.63
|
| Rate for Payer: One Health Plan of WY PPO |
$4,047.40
|
| Rate for Payer: PacificSource Commercial |
$3,717.00
|
| Rate for Payer: PHCS PPO |
$4,047.40
|
| Rate for Payer: Three Rivers PPO |
$3,097.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,395.40
|
| Rate for Payer: United Healthcare Commercial |
$3,593.10
|
| Rate for Payer: United Healthcare Medicare |
$2,395.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4,047.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,923.50
|
|
|
HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
3506232801
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,589.51 |
| Max. Negotiated Rate |
$4,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,047.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,964.80
|
| Rate for Payer: Altius Commercial |
$3,964.80
|
| Rate for Payer: Beech Street Commercial |
$4,047.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,390.73
|
| Rate for Payer: Cash Price |
$2,891.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,006.10
|
| Rate for Payer: Cigna of WY Commercial |
$4,047.40
|
| Rate for Payer: Entrust Commercial |
$3,923.50
|
| Rate for Payer: First Choice Health Commercial |
$3,923.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,923.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,725.80
|
| Rate for Payer: HealthUtah PPO |
$4,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,006.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,589.51
|
| Rate for Payer: One Health Plan of WY PPO |
$4,047.40
|
| Rate for Payer: PacificSource Commercial |
$3,717.00
|
| Rate for Payer: PHCS PPO |
$4,047.40
|
| Rate for Payer: Three Rivers PPO |
$3,097.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,725.80
|
| Rate for Payer: United Healthcare Commercial |
$3,593.10
|
| Rate for Payer: United Healthcare Medicare |
$2,725.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,923.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,923.50
|
|
|
HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 62328
|
| Hospital Charge Code |
3206232801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,943.70 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,976.00
|
| Rate for Payer: Altius Commercial |
$2,976.00
|
| Rate for Payer: Beech Street Commercial |
$3,038.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,545.10
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.00
|
| Rate for Payer: Entrust Commercial |
$2,945.00
|
| Rate for Payer: First Choice Health Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,046.00
|
| Rate for Payer: HealthUtah PPO |
$3,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,943.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.00
|
| Rate for Payer: PacificSource Commercial |
$2,790.00
|
| Rate for Payer: PHCS PPO |
$3,038.00
|
| Rate for Payer: Three Rivers PPO |
$2,325.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,046.00
|
| Rate for Payer: United Healthcare Commercial |
$2,697.00
|
| Rate for Payer: United Healthcare Medicare |
$2,046.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,945.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,945.00
|
|
|
HC DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 57170
|
| Hospital Charge Code |
5105717001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.36
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.14
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$24.36
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$24.36
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 57170
|
| Hospital Charge Code |
5105717001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$26.33
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC DIFFUSING CAPACITY - CARBON MONOXIDE DIFFUSING CAPACITY
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$250.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.40
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$209.38
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$220.40
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$220.40
|
| Rate for Payer: WINHealth Partners Commercial |
$372.40
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC DIFFUSING CAPACITY - CARBON MONOXIDE DIFFUSING CAPACITY
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.80
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$238.26
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$250.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$250.80
|
| Rate for Payer: WINHealth Partners Commercial |
$361.00
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
5105780001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.36
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.24
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.28
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$63.92
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$67.28
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$67.28
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
5105780001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.36
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.24
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.56
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$72.73
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$76.56
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
5105812001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
5105812001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC DIRECT ADMIT TO OBSERVATION
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
762G037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$429.78 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Aetna of WY Medicare |
$514.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.40
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$429.78
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$452.40
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$452.40
|
| Rate for Payer: WINHealth Partners Commercial |
$764.40
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC DIRECT ADMIT TO OBSERVATION
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
762G037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$489.06 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.80
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$489.06
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$514.80
|
| Rate for Payer: WINHealth Partners Commercial |
$741.00
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC DNA ANTIBODY, SINGLE STRAND - DNA ANTIBODY, SINGLE STRAND
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
3028622601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC DNA ANTIBODY, SINGLE STRAND - DNA ANTIBODY, SINGLE STRAND
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 86226
|
| Hospital Charge Code |
3028622601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC DOPPLER FETAL UMBILICAL ARTERY
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
4027682002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
