|
HC FETAL CONGENITAL ABNORMALITIES ARUP
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 81511
|
| Hospital Charge Code |
3108151101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$360.52 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$563.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.00
|
| Rate for Payer: Altius Commercial |
$552.00
|
| Rate for Payer: Beech Street Commercial |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.08
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$557.75
|
| Rate for Payer: Cigna of WY Commercial |
$563.50
|
| Rate for Payer: Entrust Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.50
|
| Rate for Payer: HealthUtah PPO |
$575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$557.75
|
| Rate for Payer: Multiplan Medicare/VA |
$360.52
|
| Rate for Payer: One Health Plan of WY PPO |
$563.50
|
| Rate for Payer: PacificSource Commercial |
$517.50
|
| Rate for Payer: PHCS PPO |
$563.50
|
| Rate for Payer: Three Rivers PPO |
$431.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.50
|
| Rate for Payer: United Healthcare Commercial |
$500.25
|
| Rate for Payer: United Healthcare Medicare |
$379.50
|
| Rate for Payer: WINHealth Partners Commercial |
$546.25
|
| Rate for Payer: Wise Provider Network Commercial |
$546.25
|
|
|
HC FETAL CONTRACTION STRESS TEST
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
5105902001
|
|
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 FETAL CONTRACTION STRESS TEST
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
5105902001
|
|
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 FETAL NON-STRESS TEST
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$403.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$395.52
|
| Rate for Payer: Altius Commercial |
$395.52
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$403.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$399.64
|
| Rate for Payer: Cigna of WY Commercial |
$403.76
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: Entrust Commercial |
$391.40
|
| Rate for Payer: First Choice Health Commercial |
$391.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$271.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$412.00
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$399.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$258.32
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: One Health Plan of WY PPO |
$403.76
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PacificSource Commercial |
$370.80
|
| Rate for Payer: PHCS PPO |
$403.76
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$309.00
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$271.92
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$271.92
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: WINHealth Partners Commercial |
$391.40
|
| Rate for Payer: Wise Provider Network Commercial |
$391.40
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$227.01 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$403.76
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$271.92
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$395.52
|
| Rate for Payer: Altius Commercial |
$395.52
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$403.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$338.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$399.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Cigna of WY Commercial |
$403.76
|
| Rate for Payer: Entrust Commercial |
$391.40
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$238.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: HealthUtah PPO |
$412.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$399.64
|
| Rate for Payer: Multiplan Medicare/VA |
$227.01
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: One Health Plan of WY PPO |
$403.76
|
| Rate for Payer: PacificSource Commercial |
$370.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: PHCS PPO |
$403.76
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: Three Rivers PPO |
$309.00
|
| Rate for Payer: TriWest Veterans Administration |
$238.96
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$358.44
|
| Rate for Payer: United Healthcare Medicare |
$238.96
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: WINHealth Partners Commercial |
$403.76
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$391.40
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$241.40 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$369.60
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.08
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.10
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$241.40
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
| Rate for Payer: WINHealth Partners Commercial |
$365.75
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$212.14 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$254.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$369.60
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.08
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.30
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$212.14
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$223.30
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$223.30
|
| Rate for Payer: WINHealth Partners Commercial |
$377.30
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC FINE NEEDLE ASPIRATION BX THYROID W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000503
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,692.90 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,592.00
|
| Rate for Payer: Altius Commercial |
$2,592.00
|
| Rate for Payer: Beech Street Commercial |
$2,646.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,216.70
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: Entrust Commercial |
$2,565.00
|
| Rate for Payer: First Choice Health Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,782.00
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,692.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,646.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,782.00
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$1,782.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,565.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,565.00
|
|
|
HC FINE NEEDLE ASPIRATION BX THYROID W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000503
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,487.70 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,782.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,592.00
|
| Rate for Payer: Altius Commercial |
$2,592.00
|
| Rate for Payer: Beech Street Commercial |
$2,646.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,216.70
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: Entrust Commercial |
$2,565.00
|
| Rate for Payer: First Choice Health Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,566.00
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,487.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,646.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,566.00
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$1,566.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,565.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$934.23 |
| Max. Negotiated Rate |
$1,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,460.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,430.40
|
| Rate for Payer: Altius Commercial |
$1,430.40
|
| Rate for Payer: Beech Street Commercial |
$1,460.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,223.29
|
| Rate for Payer: Cash Price |
$1,043.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,445.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,460.20
|
| Rate for Payer: Entrust Commercial |
$1,415.50
|
| Rate for Payer: First Choice Health Commercial |
$1,415.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,415.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$983.40
|
| Rate for Payer: HealthUtah PPO |
$1,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,445.30
|
| Rate for Payer: Multiplan Medicare/VA |
$934.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,460.20
|
| Rate for Payer: PacificSource Commercial |
$1,341.00
|
| Rate for Payer: PHCS PPO |
$1,460.20
|
| Rate for Payer: Three Rivers PPO |
$1,117.50
|
| Rate for Payer: TriWest Veterans Administration |
$983.40
|
| Rate for Payer: United Healthcare Commercial |
$1,296.30
|
| Rate for Payer: United Healthcare Medicare |
$983.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,415.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,415.50
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4021104401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4,765.20 |
| Max. Negotiated Rate |
$7,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,448.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,296.00
|
| Rate for Payer: Altius Commercial |
$7,296.00
|
| Rate for Payer: Beech Street Commercial |
$7,448.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,239.60
|
| Rate for Payer: Cash Price |
$5,320.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,372.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,448.00
|
| Rate for Payer: Entrust Commercial |
$7,220.00
|
| Rate for Payer: First Choice Health Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,016.00
|
| Rate for Payer: HealthUtah PPO |
$7,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,372.00
|
| Rate for Payer: Multiplan Medicare/VA |
$4,765.20
|
| Rate for Payer: One Health Plan of WY PPO |
$7,448.00
|
| Rate for Payer: PacificSource Commercial |
$6,840.00
|
| Rate for Payer: PHCS PPO |
$7,448.00
|
| Rate for Payer: Three Rivers PPO |
$5,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,016.00
|
| Rate for Payer: United Healthcare Commercial |
$6,612.00
|
| Rate for Payer: United Healthcare Medicare |
$5,016.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,220.00
|
| Rate for Payer: Wise Provider Network Commercial |
$7,220.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4021104401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4,187.60 |
| Max. Negotiated Rate |
$7,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,448.00
|
| Rate for Payer: Aetna of WY Medicare |
$5,016.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,296.00
|
| Rate for Payer: Altius Commercial |
$7,296.00
|
| Rate for Payer: Beech Street Commercial |
$7,448.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,239.60
|
| Rate for Payer: Cash Price |
$5,320.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,372.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,448.00
|
| Rate for Payer: Entrust Commercial |
$7,220.00
|
| Rate for Payer: First Choice Health Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,408.00
|
| Rate for Payer: HealthUtah PPO |
$7,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,372.00
|
| Rate for Payer: Multiplan Medicare/VA |
$4,187.60
|
| Rate for Payer: One Health Plan of WY PPO |
$7,448.00
|
| Rate for Payer: PacificSource Commercial |
$6,840.00
|
| Rate for Payer: PHCS PPO |
$7,448.00
|
| Rate for Payer: Three Rivers PPO |
$5,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$4,408.00
|
| Rate for Payer: United Healthcare Commercial |
$6,612.00
|
| Rate for Payer: United Healthcare Medicare |
$4,408.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,448.00
|
| Rate for Payer: Wise Provider Network Commercial |
$7,220.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$820.99 |
| Max. Negotiated Rate |
$1,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,460.20
|
| Rate for Payer: Aetna of WY Medicare |
$983.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,430.40
|
| Rate for Payer: Altius Commercial |
$1,430.40
|
| Rate for Payer: Beech Street Commercial |
$1,460.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,223.29
|
| Rate for Payer: Cash Price |
$1,043.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,445.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,460.20
|
| Rate for Payer: Entrust Commercial |
$1,415.50
|
| Rate for Payer: First Choice Health Commercial |
$1,415.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,415.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$864.20
|
| Rate for Payer: HealthUtah PPO |
$1,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,445.30
|
| Rate for Payer: Multiplan Medicare/VA |
$820.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1,460.20
|
| Rate for Payer: PacificSource Commercial |
$1,341.00
|
| Rate for Payer: PHCS PPO |
$1,460.20
|
| Rate for Payer: Three Rivers PPO |
$1,117.50
|
| Rate for Payer: TriWest Veterans Administration |
$864.20
|
| Rate for Payer: United Healthcare Commercial |
$1,296.30
|
| Rate for Payer: United Healthcare Medicare |
$864.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,460.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,415.50
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION LT
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000502
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,289.34 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,293.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,544.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,246.40
|
| Rate for Payer: Altius Commercial |
$2,246.40
|
| Rate for Payer: Beech Street Commercial |
$2,293.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,921.14
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,269.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,293.20
|
| Rate for Payer: Entrust Commercial |
$2,223.00
|
| Rate for Payer: First Choice Health Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,357.20
|
| Rate for Payer: HealthUtah PPO |
$2,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,269.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,289.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,293.20
|
| Rate for Payer: PacificSource Commercial |
$2,106.00
|
| Rate for Payer: PHCS PPO |
$2,293.20
|
| Rate for Payer: Three Rivers PPO |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,357.20
|
| Rate for Payer: United Healthcare Commercial |
$2,035.80
|
| Rate for Payer: United Healthcare Medicare |
$1,357.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,293.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2,223.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION LT
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
4021000502
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,467.18 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,293.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,246.40
|
| Rate for Payer: Altius Commercial |
$2,246.40
|
| Rate for Payer: Beech Street Commercial |
$2,293.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,921.14
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,269.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,293.20
|
| Rate for Payer: Entrust Commercial |
$2,223.00
|
| Rate for Payer: First Choice Health Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,544.40
|
| Rate for Payer: HealthUtah PPO |
$2,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,269.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,467.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,293.20
|
| Rate for Payer: PacificSource Commercial |
$2,106.00
|
| Rate for Payer: PHCS PPO |
$2,293.20
|
| Rate for Payer: Three Rivers PPO |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,544.40
|
| Rate for Payer: United Healthcare Commercial |
$2,035.80
|
| Rate for Payer: United Healthcare Medicare |
$1,544.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,223.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,223.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION RT
|
Facility
|
IP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4021104403
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4,765.20 |
| Max. Negotiated Rate |
$7,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,448.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,296.00
|
| Rate for Payer: Altius Commercial |
$7,296.00
|
| Rate for Payer: Beech Street Commercial |
$7,448.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,239.60
|
| Rate for Payer: Cash Price |
$5,320.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,372.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,448.00
|
| Rate for Payer: Entrust Commercial |
$7,220.00
|
| Rate for Payer: First Choice Health Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,016.00
|
| Rate for Payer: HealthUtah PPO |
$7,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,372.00
|
| Rate for Payer: Multiplan Medicare/VA |
$4,765.20
|
| Rate for Payer: One Health Plan of WY PPO |
$7,448.00
|
| Rate for Payer: PacificSource Commercial |
$6,840.00
|
| Rate for Payer: PHCS PPO |
$7,448.00
|
| Rate for Payer: Three Rivers PPO |
$5,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,016.00
|
| Rate for Payer: United Healthcare Commercial |
$6,612.00
|
| Rate for Payer: United Healthcare Medicare |
$5,016.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,220.00
|
| Rate for Payer: Wise Provider Network Commercial |
$7,220.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION RT
|
Facility
|
OP
|
$7,600.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
4021104403
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4,187.60 |
| Max. Negotiated Rate |
$7,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,448.00
|
| Rate for Payer: Aetna of WY Medicare |
$5,016.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,296.00
|
| Rate for Payer: Altius Commercial |
$7,296.00
|
| Rate for Payer: Beech Street Commercial |
$7,448.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,239.60
|
| Rate for Payer: Cash Price |
$5,320.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,372.00
|
| Rate for Payer: Cigna of WY Commercial |
$7,448.00
|
| Rate for Payer: Entrust Commercial |
$7,220.00
|
| Rate for Payer: First Choice Health Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,220.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,408.00
|
| Rate for Payer: HealthUtah PPO |
$7,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,372.00
|
| Rate for Payer: Multiplan Medicare/VA |
$4,187.60
|
| Rate for Payer: One Health Plan of WY PPO |
$7,448.00
|
| Rate for Payer: PacificSource Commercial |
$6,840.00
|
| Rate for Payer: PHCS PPO |
$7,448.00
|
| Rate for Payer: Three Rivers PPO |
$5,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$4,408.00
|
| Rate for Payer: United Healthcare Commercial |
$6,612.00
|
| Rate for Payer: United Healthcare Medicare |
$4,408.00
|
| Rate for Payer: WINHealth Partners Commercial |
$7,448.00
|
| Rate for Payer: Wise Provider Network Commercial |
$7,220.00
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
3611000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.57 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,048.60
|
| Rate for Payer: Aetna of WY Medicare |
$706.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,027.20
|
| Rate for Payer: Altius Commercial |
$1,027.20
|
| Rate for Payer: Beech Street Commercial |
$1,048.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$878.47
|
| Rate for Payer: Cash Price |
$749.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,037.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,048.60
|
| Rate for Payer: Entrust Commercial |
$1,016.50
|
| Rate for Payer: First Choice Health Commercial |
$1,016.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,016.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$620.60
|
| Rate for Payer: HealthUtah PPO |
$1,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,037.90
|
| Rate for Payer: Multiplan Medicare/VA |
$589.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,048.60
|
| Rate for Payer: PacificSource Commercial |
$963.00
|
| Rate for Payer: PHCS PPO |
$1,048.60
|
| Rate for Payer: Three Rivers PPO |
$802.50
|
| Rate for Payer: TriWest Veterans Administration |
$620.60
|
| Rate for Payer: United Healthcare Commercial |
$930.90
|
| Rate for Payer: United Healthcare Medicare |
$620.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,048.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,016.50
|
|
|
HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
3611000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.89 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,048.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,027.20
|
| Rate for Payer: Altius Commercial |
$1,027.20
|
| Rate for Payer: Beech Street Commercial |
$1,048.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$878.47
|
| Rate for Payer: Cash Price |
$749.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,037.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,048.60
|
| Rate for Payer: Entrust Commercial |
$1,016.50
|
| Rate for Payer: First Choice Health Commercial |
$1,016.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,016.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$706.20
|
| Rate for Payer: HealthUtah PPO |
$1,070.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,037.90
|
| Rate for Payer: Multiplan Medicare/VA |
$670.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,048.60
|
| Rate for Payer: PacificSource Commercial |
$963.00
|
| Rate for Payer: PHCS PPO |
$1,048.60
|
| Rate for Payer: Three Rivers PPO |
$802.50
|
| Rate for Payer: TriWest Veterans Administration |
$706.20
|
| Rate for Payer: United Healthcare Commercial |
$930.90
|
| Rate for Payer: United Healthcare Medicare |
$706.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,016.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,016.50
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
7611002101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
7611002101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
5101002101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| 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 |
$45.16
|
| 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 |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| 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 |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
5101002101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.30 |
| 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 Auto/Workers Compensation |
$52.80
|
| 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 |
$45.16
|
| 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 |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| 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 |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
