|
HC BREAST TOMOSYNTHESIS BI - MAMMO BREAST SCREENING TOMOSYNTHESIS RIGHT
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
4037706303
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$84.48
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.96
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$69.31
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$72.96
|
| Rate for Payer: WINHealth Partners Commercial |
$125.44
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS LT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 77061
|
| Hospital Charge Code |
4017706101
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$35.20
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.55
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$31.87
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.55
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
| Rate for Payer: United Healthcare Medicare |
$33.55
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS LT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 77061
|
| Hospital Charge Code |
4017706101
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS RT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 77061
|
| Hospital Charge Code |
4017706102
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$35.20
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.55
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$31.87
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.55
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
| Rate for Payer: United Healthcare Medicare |
$33.55
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC BREAST TOMOSYNTHESIS UNI - MAMMO BREAST DIAGNOSTIC TOMOSYNTHESIS RT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 77061
|
| Hospital Charge Code |
4017706102
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.35
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$52.52
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 91065
|
| Hospital Charge Code |
3009106501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$560.38 |
| Max. Negotiated Rate |
$967.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$947.66
|
| Rate for Payer: Aetna of WY Medicare |
$618.88
|
| Rate for Payer: Altius Commercial |
$928.32
|
| Rate for Payer: Beech Street Commercial |
$947.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$937.99
|
| Rate for Payer: Cash Price |
$676.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.99
|
| Rate for Payer: Cigna of WY Commercial |
$947.66
|
| Rate for Payer: Entrust Commercial |
$918.65
|
| Rate for Payer: First Choice Health Commercial |
$918.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$918.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$589.87
|
| Rate for Payer: HealthUtah PPO |
$967.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.99
|
| Rate for Payer: Multiplan Medicare/VA |
$560.38
|
| Rate for Payer: One Health Plan of WY PPO |
$947.66
|
| Rate for Payer: PacificSource Commercial |
$870.30
|
| Rate for Payer: PHCS PPO |
$947.66
|
| Rate for Payer: Three Rivers PPO |
$725.25
|
| Rate for Payer: TriWest Veterans Administration |
$589.87
|
| Rate for Payer: United Healthcare Commercial |
$923.48
|
| Rate for Payer: United Healthcare Medicare |
$589.87
|
| Rate for Payer: WINHealth Partners Commercial |
$918.65
|
| Rate for Payer: Wise Provider Network Commercial |
$918.65
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
HCPCS 91065
|
| Hospital Charge Code |
7509106501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$498.72 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$902.58
|
| Rate for Payer: Aetna of WY Medicare |
$607.86
|
| Rate for Payer: Altius Commercial |
$884.16
|
| Rate for Payer: Beech Street Commercial |
$902.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$893.37
|
| Rate for Payer: Cash Price |
$644.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$893.37
|
| Rate for Payer: Cigna of WY Commercial |
$902.58
|
| Rate for Payer: Entrust Commercial |
$874.95
|
| Rate for Payer: First Choice Health Commercial |
$874.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.97
|
| Rate for Payer: HealthUtah PPO |
$921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$893.37
|
| Rate for Payer: Multiplan Medicare/VA |
$498.72
|
| Rate for Payer: One Health Plan of WY PPO |
$902.58
|
| Rate for Payer: PacificSource Commercial |
$828.90
|
| Rate for Payer: PHCS PPO |
$902.58
|
| Rate for Payer: Three Rivers PPO |
$690.75
|
| Rate for Payer: TriWest Veterans Administration |
$524.97
|
| Rate for Payer: United Healthcare Commercial |
$879.56
|
| Rate for Payer: United Healthcare Medicare |
$524.97
|
| Rate for Payer: WINHealth Partners Commercial |
$902.58
|
| Rate for Payer: Wise Provider Network Commercial |
$874.95
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
HCPCS 91065
|
| Hospital Charge Code |
7509106501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$902.58
|
| Rate for Payer: Aetna of WY Medicare |
$589.44
|
| Rate for Payer: Altius Commercial |
$884.16
|
| Rate for Payer: Beech Street Commercial |
$902.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$893.37
|
| Rate for Payer: Cash Price |
$644.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$893.37
|
| Rate for Payer: Cigna of WY Commercial |
$902.58
|
| Rate for Payer: Entrust Commercial |
$874.95
|
| Rate for Payer: First Choice Health Commercial |
$874.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$561.81
|
| Rate for Payer: HealthUtah PPO |
$921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$893.37
|
| Rate for Payer: Multiplan Medicare/VA |
$533.72
|
| Rate for Payer: One Health Plan of WY PPO |
$902.58
|
| Rate for Payer: PacificSource Commercial |
$828.90
|
| Rate for Payer: PHCS PPO |
$902.58
|
| Rate for Payer: Three Rivers PPO |
$690.75
|
| Rate for Payer: TriWest Veterans Administration |
$561.81
|
| Rate for Payer: United Healthcare Commercial |
$879.56
|
| Rate for Payer: United Healthcare Medicare |
$561.81
|
| Rate for Payer: WINHealth Partners Commercial |
$874.95
|
| Rate for Payer: Wise Provider Network Commercial |
$874.95
|
|
|
HC BREATH HYDROGEN/METHANE TEST - BREATH HYDROGEN TEST
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 91065
|
| Hospital Charge Code |
3009106501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$523.63 |
| Max. Negotiated Rate |
$967.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$947.66
|
| Rate for Payer: Aetna of WY Medicare |
$638.22
|
| Rate for Payer: Altius Commercial |
$928.32
|
| Rate for Payer: Beech Street Commercial |
$947.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$937.99
|
| Rate for Payer: Cash Price |
$676.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$937.99
|
| Rate for Payer: Cigna of WY Commercial |
$947.66
|
| Rate for Payer: Entrust Commercial |
$918.65
|
| Rate for Payer: First Choice Health Commercial |
$918.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$918.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$551.19
|
| Rate for Payer: HealthUtah PPO |
$967.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$937.99
|
| Rate for Payer: Multiplan Medicare/VA |
$523.63
|
| Rate for Payer: One Health Plan of WY PPO |
$947.66
|
| Rate for Payer: PacificSource Commercial |
$870.30
|
| Rate for Payer: PHCS PPO |
$947.66
|
| Rate for Payer: Three Rivers PPO |
$725.25
|
| Rate for Payer: TriWest Veterans Administration |
$551.19
|
| Rate for Payer: United Healthcare Commercial |
$923.48
|
| Rate for Payer: United Healthcare Medicare |
$551.19
|
| Rate for Payer: WINHealth Partners Commercial |
$947.66
|
| Rate for Payer: Wise Provider Network Commercial |
$918.65
|
|
|
HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$155.76
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.52
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$127.79
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$134.52
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$134.52
|
| Rate for Payer: WINHealth Partners Commercial |
$231.28
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
|
HC BREATHING CAPACITY TEST - SPIROMETRY WITHOUT BRONCHODILATOR
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$136.76 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$151.04
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.96
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$136.76
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.96
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$143.96
|
| Rate for Payer: WINHealth Partners Commercial |
$224.20
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
|
HC BRONCHOSCOPY PROCEDURE
|
Facility
|
IP
|
$576.00
|
|
| Hospital Charge Code |
3600000038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Aetna of WY Medicare |
$368.64
|
| Rate for Payer: Altius Commercial |
$552.96
|
| Rate for Payer: Beech Street Commercial |
$564.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.72
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: Entrust Commercial |
$547.20
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.36
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$333.79
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$564.48
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$351.36
|
| Rate for Payer: United Healthcare Commercial |
$550.08
|
| Rate for Payer: United Healthcare Medicare |
$351.36
|
| Rate for Payer: WINHealth Partners Commercial |
$547.20
|
| Rate for Payer: Wise Provider Network Commercial |
$547.20
|
|
|
HC BRONCHOSCOPY PROCEDURE
|
Facility
|
OP
|
$576.00
|
|
| Hospital Charge Code |
3600000038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.90 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Aetna of WY Medicare |
$380.16
|
| Rate for Payer: Altius Commercial |
$552.96
|
| Rate for Payer: Beech Street Commercial |
$564.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.72
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: Entrust Commercial |
$547.20
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.32
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$311.90
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$564.48
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$328.32
|
| Rate for Payer: United Healthcare Commercial |
$550.08
|
| Rate for Payer: United Healthcare Medicare |
$328.32
|
| Rate for Payer: WINHealth Partners Commercial |
$564.48
|
| Rate for Payer: Wise Provider Network Commercial |
$547.20
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.08
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.42
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$70.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$74.42
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,465.30 |
| Max. Negotiated Rate |
$2,706.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,651.88
|
| Rate for Payer: Aetna of WY Medicare |
$1,785.96
|
| Rate for Payer: Altius Commercial |
$2,597.76
|
| Rate for Payer: Beech Street Commercial |
$2,651.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,624.82
|
| Rate for Payer: Cash Price |
$1,894.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,624.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,651.88
|
| Rate for Payer: Entrust Commercial |
$2,570.70
|
| Rate for Payer: First Choice Health Commercial |
$2,570.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,570.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,542.42
|
| Rate for Payer: HealthUtah PPO |
$2,706.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,624.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1,465.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,651.88
|
| Rate for Payer: PacificSource Commercial |
$2,435.40
|
| Rate for Payer: PHCS PPO |
$2,651.88
|
| Rate for Payer: Three Rivers PPO |
$2,029.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,542.42
|
| Rate for Payer: United Healthcare Commercial |
$2,584.23
|
| Rate for Payer: United Healthcare Medicare |
$1,542.42
|
| Rate for Payer: WINHealth Partners Commercial |
$2,651.88
|
| Rate for Payer: Wise Provider Network Commercial |
$2,570.70
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,568.13 |
| Max. Negotiated Rate |
$2,706.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,651.88
|
| Rate for Payer: Aetna of WY Medicare |
$1,731.84
|
| Rate for Payer: Altius Commercial |
$2,597.76
|
| Rate for Payer: Beech Street Commercial |
$2,651.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,624.82
|
| Rate for Payer: Cash Price |
$1,894.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,624.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,651.88
|
| Rate for Payer: Entrust Commercial |
$2,570.70
|
| Rate for Payer: First Choice Health Commercial |
$2,570.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,570.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.66
|
| Rate for Payer: HealthUtah PPO |
$2,706.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,624.82
|
| Rate for Payer: Multiplan Medicare/VA |
$1,568.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,651.88
|
| Rate for Payer: PacificSource Commercial |
$2,435.40
|
| Rate for Payer: PHCS PPO |
$2,651.88
|
| Rate for Payer: Three Rivers PPO |
$2,029.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.66
|
| Rate for Payer: United Healthcare Commercial |
$2,584.23
|
| Rate for Payer: United Healthcare Medicare |
$1,650.66
|
| Rate for Payer: WINHealth Partners Commercial |
$2,570.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,570.70
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
6101908401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,594.20 |
| Max. Negotiated Rate |
$2,751.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,695.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,760.64
|
| Rate for Payer: Altius Commercial |
$2,640.96
|
| Rate for Payer: Beech Street Commercial |
$2,695.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,668.47
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,668.47
|
| Rate for Payer: Cigna of WY Commercial |
$2,695.98
|
| Rate for Payer: Entrust Commercial |
$2,613.45
|
| Rate for Payer: First Choice Health Commercial |
$2,613.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,613.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,678.11
|
| Rate for Payer: HealthUtah PPO |
$2,751.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,668.47
|
| Rate for Payer: Multiplan Medicare/VA |
$1,594.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,695.98
|
| Rate for Payer: PacificSource Commercial |
$2,475.90
|
| Rate for Payer: PHCS PPO |
$2,695.98
|
| Rate for Payer: Three Rivers PPO |
$2,063.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,678.11
|
| Rate for Payer: United Healthcare Commercial |
$2,627.20
|
| Rate for Payer: United Healthcare Medicare |
$1,678.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,613.45
|
| Rate for Payer: Wise Provider Network Commercial |
$2,613.45
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4021908401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,386.16 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,344.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,530.88
|
| Rate for Payer: Altius Commercial |
$2,296.32
|
| Rate for Payer: Beech Street Commercial |
$2,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,320.24
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,320.24
|
| Rate for Payer: Cigna of WY Commercial |
$2,344.16
|
| Rate for Payer: Entrust Commercial |
$2,272.40
|
| Rate for Payer: First Choice Health Commercial |
$2,272.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,272.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,459.12
|
| Rate for Payer: HealthUtah PPO |
$2,392.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,320.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,386.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,344.16
|
| Rate for Payer: PacificSource Commercial |
$2,152.80
|
| Rate for Payer: PHCS PPO |
$2,344.16
|
| Rate for Payer: Three Rivers PPO |
$1,794.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,459.12
|
| Rate for Payer: United Healthcare Commercial |
$2,284.36
|
| Rate for Payer: United Healthcare Medicare |
$1,459.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,272.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,272.40
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
4021908401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,295.27 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,344.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,578.72
|
| Rate for Payer: Altius Commercial |
$2,296.32
|
| Rate for Payer: Beech Street Commercial |
$2,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,320.24
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,320.24
|
| Rate for Payer: Cigna of WY Commercial |
$2,344.16
|
| Rate for Payer: Entrust Commercial |
$2,272.40
|
| Rate for Payer: First Choice Health Commercial |
$2,272.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,272.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,363.44
|
| Rate for Payer: HealthUtah PPO |
$2,392.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,320.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,295.27
|
| Rate for Payer: One Health Plan of WY PPO |
$2,344.16
|
| Rate for Payer: PacificSource Commercial |
$2,152.80
|
| Rate for Payer: PHCS PPO |
$2,344.16
|
| Rate for Payer: Three Rivers PPO |
$1,794.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,363.44
|
| Rate for Payer: United Healthcare Commercial |
$2,284.36
|
| Rate for Payer: United Healthcare Medicare |
$1,363.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,344.16
|
| Rate for Payer: Wise Provider Network Commercial |
$2,272.40
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
6101908401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,489.67 |
| Max. Negotiated Rate |
$2,751.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,695.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,815.66
|
| Rate for Payer: Altius Commercial |
$2,640.96
|
| Rate for Payer: Beech Street Commercial |
$2,695.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,668.47
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,668.47
|
| Rate for Payer: Cigna of WY Commercial |
$2,695.98
|
| Rate for Payer: Entrust Commercial |
$2,613.45
|
| Rate for Payer: First Choice Health Commercial |
$2,613.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,613.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,568.07
|
| Rate for Payer: HealthUtah PPO |
$2,751.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,668.47
|
| Rate for Payer: Multiplan Medicare/VA |
$1,489.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,695.98
|
| Rate for Payer: PacificSource Commercial |
$2,475.90
|
| Rate for Payer: PHCS PPO |
$2,695.98
|
| Rate for Payer: Three Rivers PPO |
$2,063.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,568.07
|
| Rate for Payer: United Healthcare Commercial |
$2,627.20
|
| Rate for Payer: United Healthcare Medicare |
$1,568.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,695.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2,613.45
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.02 |
| 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 Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| 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 |
$62.13
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$59.02
|
| 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 |
$62.13
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| 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 |
$105.73
|
| 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 |
$66.49
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$63.17
|
| 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 |
$66.49
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$66.49
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86628
|
| Hospital Charge Code |
3028662801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.72
|
| Rate for Payer: Aetna of WY Medicare |
$72.96
|
| Rate for Payer: Altius Commercial |
$109.44
|
| Rate for Payer: Beech Street Commercial |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.58
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.58
|
| Rate for Payer: Cigna of WY Commercial |
$111.72
|
| Rate for Payer: Entrust Commercial |
$108.30
|
| Rate for Payer: First Choice Health Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.58
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$111.72
|
| Rate for Payer: PacificSource Commercial |
$102.60
|
| Rate for Payer: PHCS PPO |
$111.72
|
| Rate for Payer: Three Rivers PPO |
$85.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$108.87
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$108.30
|
| Rate for Payer: Wise Provider Network Commercial |
$108.30
|
|
|
HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86628
|
| Hospital Charge Code |
3028662801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.72
|
| Rate for Payer: Aetna of WY Medicare |
$75.24
|
| Rate for Payer: Altius Commercial |
$109.44
|
| Rate for Payer: Beech Street Commercial |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.58
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.58
|
| Rate for Payer: Cigna of WY Commercial |
$111.72
|
| Rate for Payer: Entrust Commercial |
$108.30
|
| Rate for Payer: First Choice Health Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.98
|
| Rate for Payer: HealthUtah PPO |
$114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.58
|
| Rate for Payer: Multiplan Medicare/VA |
$61.73
|
| Rate for Payer: One Health Plan of WY PPO |
$111.72
|
| Rate for Payer: PacificSource Commercial |
$102.60
|
| Rate for Payer: PHCS PPO |
$111.72
|
| Rate for Payer: Three Rivers PPO |
$85.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.98
|
| Rate for Payer: United Healthcare Commercial |
$108.87
|
| Rate for Payer: United Healthcare Medicare |
$64.98
|
| Rate for Payer: WINHealth Partners Commercial |
$111.72
|
| Rate for Payer: Wise Provider Network Commercial |
$108.30
|
|
