|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
7319322601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
7319322601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
7319322602
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
7319322602
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC ECHO 2D F-U OR LTD STUDY W BUBBLE
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330812
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$692.84 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$729.30
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$692.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$729.30
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$729.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC ECHO 2D F-U OR LTD STUDY W BUBBLE
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330812
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$608.86 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Aetna of WY Medicare |
$729.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.90
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$608.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$640.90
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$640.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,082.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC ECHOGRAPHY,TRANSVAGINAL
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$551.76 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$862.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$844.80
|
| Rate for Payer: Altius Commercial |
$844.80
|
| Rate for Payer: Beech Street Commercial |
$862.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$722.48
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$853.60
|
| Rate for Payer: Cigna of WY Commercial |
$862.40
|
| Rate for Payer: Entrust Commercial |
$836.00
|
| Rate for Payer: First Choice Health Commercial |
$836.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$836.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$580.80
|
| Rate for Payer: HealthUtah PPO |
$880.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$853.60
|
| Rate for Payer: Multiplan Medicare/VA |
$551.76
|
| Rate for Payer: One Health Plan of WY PPO |
$862.40
|
| Rate for Payer: PacificSource Commercial |
$792.00
|
| Rate for Payer: PHCS PPO |
$862.40
|
| Rate for Payer: Three Rivers PPO |
$660.00
|
| Rate for Payer: TriWest Veterans Administration |
$580.80
|
| Rate for Payer: United Healthcare Commercial |
$765.60
|
| Rate for Payer: United Healthcare Medicare |
$580.80
|
| Rate for Payer: WINHealth Partners Commercial |
$836.00
|
| Rate for Payer: Wise Provider Network Commercial |
$836.00
|
|
|
HC ECHOGRAPHY,TRANSVAGINAL
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$484.88 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$862.40
|
| Rate for Payer: Aetna of WY Medicare |
$580.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$844.80
|
| Rate for Payer: Altius Commercial |
$844.80
|
| Rate for Payer: Beech Street Commercial |
$862.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$722.48
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$853.60
|
| Rate for Payer: Cigna of WY Commercial |
$862.40
|
| Rate for Payer: Entrust Commercial |
$836.00
|
| Rate for Payer: First Choice Health Commercial |
$836.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$836.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$510.40
|
| Rate for Payer: HealthUtah PPO |
$880.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$853.60
|
| Rate for Payer: Multiplan Medicare/VA |
$484.88
|
| Rate for Payer: One Health Plan of WY PPO |
$862.40
|
| Rate for Payer: PacificSource Commercial |
$792.00
|
| Rate for Payer: PHCS PPO |
$862.40
|
| Rate for Payer: Three Rivers PPO |
$660.00
|
| Rate for Payer: TriWest Veterans Administration |
$510.40
|
| Rate for Payer: United Healthcare Commercial |
$765.60
|
| Rate for Payer: United Healthcare Medicare |
$510.40
|
| Rate for Payer: WINHealth Partners Commercial |
$862.40
|
| Rate for Payer: Wise Provider Network Commercial |
$836.00
|
|
|
HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$369.17 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$656.60
|
| Rate for Payer: Aetna of WY Medicare |
$442.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$643.20
|
| Rate for Payer: Altius Commercial |
$643.20
|
| Rate for Payer: Beech Street Commercial |
$656.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$550.07
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$649.90
|
| Rate for Payer: Cigna of WY Commercial |
$656.60
|
| Rate for Payer: Entrust Commercial |
$636.50
|
| Rate for Payer: First Choice Health Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$388.60
|
| Rate for Payer: HealthUtah PPO |
$670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$649.90
|
| Rate for Payer: Multiplan Medicare/VA |
$369.17
|
| Rate for Payer: One Health Plan of WY PPO |
$656.60
|
| Rate for Payer: PacificSource Commercial |
$603.00
|
| Rate for Payer: PHCS PPO |
$656.60
|
| Rate for Payer: Three Rivers PPO |
$502.50
|
| Rate for Payer: TriWest Veterans Administration |
$388.60
|
| Rate for Payer: United Healthcare Commercial |
$582.90
|
| Rate for Payer: United Healthcare Medicare |
$388.60
|
| Rate for Payer: WINHealth Partners Commercial |
$656.60
|
| Rate for Payer: Wise Provider Network Commercial |
$636.50
|
|
|
HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$420.09 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$656.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$643.20
|
| Rate for Payer: Altius Commercial |
$643.20
|
| Rate for Payer: Beech Street Commercial |
$656.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$550.07
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$649.90
|
| Rate for Payer: Cigna of WY Commercial |
$656.60
|
| Rate for Payer: Entrust Commercial |
$636.50
|
| Rate for Payer: First Choice Health Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$636.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.20
|
| Rate for Payer: HealthUtah PPO |
$670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$649.90
|
| Rate for Payer: Multiplan Medicare/VA |
$420.09
|
| Rate for Payer: One Health Plan of WY PPO |
$656.60
|
| Rate for Payer: PacificSource Commercial |
$603.00
|
| Rate for Payer: PHCS PPO |
$656.60
|
| Rate for Payer: Three Rivers PPO |
$502.50
|
| Rate for Payer: TriWest Veterans Administration |
$442.20
|
| Rate for Payer: United Healthcare Commercial |
$582.90
|
| Rate for Payer: United Healthcare Medicare |
$442.20
|
| Rate for Payer: WINHealth Partners Commercial |
$636.50
|
| Rate for Payer: Wise Provider Network Commercial |
$636.50
|
|
|
HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
4027685601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$498.66 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$886.90
|
| Rate for Payer: Aetna of WY Medicare |
$597.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$868.80
|
| Rate for Payer: Altius Commercial |
$868.80
|
| Rate for Payer: Beech Street Commercial |
$886.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.00
|
| Rate for Payer: Cash Price |
$633.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$877.85
|
| Rate for Payer: Cigna of WY Commercial |
$886.90
|
| Rate for Payer: Entrust Commercial |
$859.75
|
| Rate for Payer: First Choice Health Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.90
|
| Rate for Payer: HealthUtah PPO |
$905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$877.85
|
| Rate for Payer: Multiplan Medicare/VA |
$498.66
|
| Rate for Payer: One Health Plan of WY PPO |
$886.90
|
| Rate for Payer: PacificSource Commercial |
$814.50
|
| Rate for Payer: PHCS PPO |
$886.90
|
| Rate for Payer: Three Rivers PPO |
$678.75
|
| Rate for Payer: TriWest Veterans Administration |
$524.90
|
| Rate for Payer: United Healthcare Commercial |
$787.35
|
| Rate for Payer: United Healthcare Medicare |
$524.90
|
| Rate for Payer: WINHealth Partners Commercial |
$886.90
|
| Rate for Payer: Wise Provider Network Commercial |
$859.75
|
|
|
HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
4027685601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$567.44 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$886.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$868.80
|
| Rate for Payer: Altius Commercial |
$868.80
|
| Rate for Payer: Beech Street Commercial |
$886.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.00
|
| Rate for Payer: Cash Price |
$633.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$877.85
|
| Rate for Payer: Cigna of WY Commercial |
$886.90
|
| Rate for Payer: Entrust Commercial |
$859.75
|
| Rate for Payer: First Choice Health Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$597.30
|
| Rate for Payer: HealthUtah PPO |
$905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$877.85
|
| Rate for Payer: Multiplan Medicare/VA |
$567.44
|
| Rate for Payer: One Health Plan of WY PPO |
$886.90
|
| Rate for Payer: PacificSource Commercial |
$814.50
|
| Rate for Payer: PHCS PPO |
$886.90
|
| Rate for Payer: Three Rivers PPO |
$678.75
|
| Rate for Payer: TriWest Veterans Administration |
$597.30
|
| Rate for Payer: United Healthcare Commercial |
$787.35
|
| Rate for Payer: United Healthcare Medicare |
$597.30
|
| Rate for Payer: WINHealth Partners Commercial |
$859.75
|
| Rate for Payer: Wise Provider Network Commercial |
$859.75
|
|
|
HC ECHO,SCROTUM & CONTENTS - US SCROTUM
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC ECHO,SCROTUM & CONTENTS - US SCROTUM
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC ECHO,TRANSRECTAL - US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4027687202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$376.20
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
| Rate for Payer: WINHealth Partners Commercial |
$570.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC ECHO,TRANSRECTAL - US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
4027687202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$396.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$330.60
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$348.00
|
| Rate for Payer: WINHealth Partners Commercial |
$588.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC EEG DURING SURGERY - EEG DURING NONINTRACRANIAL SURGERY
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS 95955
|
| Hospital Charge Code |
7409595502
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,008.22 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,575.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,543.68
|
| Rate for Payer: Altius Commercial |
$1,543.68
|
| Rate for Payer: Beech Street Commercial |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,320.17
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,559.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,575.84
|
| Rate for Payer: Entrust Commercial |
$1,527.60
|
| Rate for Payer: First Choice Health Commercial |
$1,527.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,527.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,061.28
|
| Rate for Payer: HealthUtah PPO |
$1,608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,559.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,008.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,575.84
|
| Rate for Payer: PacificSource Commercial |
$1,447.20
|
| Rate for Payer: PHCS PPO |
$1,575.84
|
| Rate for Payer: Three Rivers PPO |
$1,206.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,061.28
|
| Rate for Payer: United Healthcare Commercial |
$1,398.96
|
| Rate for Payer: United Healthcare Medicare |
$1,061.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,527.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,527.60
|
|
|
HC EEG DURING SURGERY - EEG DURING NONINTRACRANIAL SURGERY
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS 95955
|
| Hospital Charge Code |
7409595502
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$886.01 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,575.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,061.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,543.68
|
| Rate for Payer: Altius Commercial |
$1,543.68
|
| Rate for Payer: Beech Street Commercial |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,320.17
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,559.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,575.84
|
| Rate for Payer: Entrust Commercial |
$1,527.60
|
| Rate for Payer: First Choice Health Commercial |
$1,527.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,527.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$932.64
|
| Rate for Payer: HealthUtah PPO |
$1,608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,559.76
|
| Rate for Payer: Multiplan Medicare/VA |
$886.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,575.84
|
| Rate for Payer: PacificSource Commercial |
$1,447.20
|
| Rate for Payer: PHCS PPO |
$1,575.84
|
| Rate for Payer: Three Rivers PPO |
$1,206.00
|
| Rate for Payer: TriWest Veterans Administration |
$932.64
|
| Rate for Payer: United Healthcare Commercial |
$1,398.96
|
| Rate for Payer: United Healthcare Medicare |
$932.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,527.60
|
|
|
HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
7409581601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$928.44 |
| Max. Negotiated Rate |
$1,685.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,651.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,112.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,617.60
|
| Rate for Payer: Altius Commercial |
$1,617.60
|
| Rate for Payer: Beech Street Commercial |
$1,651.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,383.38
|
| Rate for Payer: Cash Price |
$1,179.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,634.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,651.30
|
| Rate for Payer: Entrust Commercial |
$1,600.75
|
| Rate for Payer: First Choice Health Commercial |
$1,600.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,600.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.30
|
| Rate for Payer: HealthUtah PPO |
$1,685.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,634.45
|
| Rate for Payer: Multiplan Medicare/VA |
$928.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,651.30
|
| Rate for Payer: PacificSource Commercial |
$1,516.50
|
| Rate for Payer: PHCS PPO |
$1,651.30
|
| Rate for Payer: Three Rivers PPO |
$1,263.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.30
|
| Rate for Payer: United Healthcare Commercial |
$1,465.95
|
| Rate for Payer: United Healthcare Medicare |
$977.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,651.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,600.75
|
|
|
HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
7409581601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,056.50 |
| Max. Negotiated Rate |
$1,685.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,651.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,617.60
|
| Rate for Payer: Altius Commercial |
$1,617.60
|
| Rate for Payer: Beech Street Commercial |
$1,651.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,383.38
|
| Rate for Payer: Cash Price |
$1,179.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,634.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,651.30
|
| Rate for Payer: Entrust Commercial |
$1,600.75
|
| Rate for Payer: First Choice Health Commercial |
$1,600.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,600.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,112.10
|
| Rate for Payer: HealthUtah PPO |
$1,685.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,634.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,056.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,651.30
|
| Rate for Payer: PacificSource Commercial |
$1,516.50
|
| Rate for Payer: PHCS PPO |
$1,651.30
|
| Rate for Payer: Three Rivers PPO |
$1,263.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,112.10
|
| Rate for Payer: United Healthcare Commercial |
$1,465.95
|
| Rate for Payer: United Healthcare Medicare |
$1,112.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,600.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,600.75
|
|
|
HC EGD PROCEDURE
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
3600000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.80
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$426.36
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$448.80
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$448.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC EGD PROCEDURE
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
3600000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Aetna of WY Medicare |
$448.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.40
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$374.68
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$394.40
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$394.40
|
| Rate for Payer: WINHealth Partners Commercial |
$666.40
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
3028666601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
3028666601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC EKG TRACING 12 LEADS FOR INITIAL PREV
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
730G040401
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
