|
HC CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7615170501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.94 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Aetna of WY Medicare |
$357.76
|
| Rate for Payer: Altius Commercial |
$536.64
|
| Rate for Payer: Beech Street Commercial |
$547.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$542.23
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: Entrust Commercial |
$531.05
|
| Rate for Payer: First Choice Health Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$340.99
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: Multiplan Medicare/VA |
$323.94
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$547.82
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: TriWest Veterans Administration |
$340.99
|
| Rate for Payer: United Healthcare Commercial |
$533.84
|
| Rate for Payer: United Healthcare Medicare |
$340.99
|
| Rate for Payer: WINHealth Partners Commercial |
$531.05
|
| Rate for Payer: Wise Provider Network Commercial |
$531.05
|
|
|
HC CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
7615170501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.70 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Aetna of WY Medicare |
$368.94
|
| Rate for Payer: Altius Commercial |
$536.64
|
| Rate for Payer: Beech Street Commercial |
$547.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$542.23
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: Entrust Commercial |
$531.05
|
| Rate for Payer: First Choice Health Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$318.63
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: Multiplan Medicare/VA |
$302.70
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$547.82
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: TriWest Veterans Administration |
$318.63
|
| Rate for Payer: United Healthcare Commercial |
$533.84
|
| Rate for Payer: United Healthcare Medicare |
$318.63
|
| Rate for Payer: WINHealth Partners Commercial |
$547.82
|
| Rate for Payer: Wise Provider Network Commercial |
$531.05
|
|
|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7611725001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
7611725001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$18.48
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.16
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.96
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$15.16
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$15.96
|
| Rate for Payer: United Healthcare Commercial |
$26.74
|
| Rate for Payer: United Healthcare Medicare |
$15.96
|
| Rate for Payer: WINHealth Partners Commercial |
$27.44
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 17250
|
| Hospital Charge Code |
5101725001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$17.92
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.16
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.08
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$16.23
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$17.08
|
| Rate for Payer: United Healthcare Commercial |
$26.74
|
| Rate for Payer: United Healthcare Medicare |
$17.08
|
| Rate for Payer: WINHealth Partners Commercial |
$26.60
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
HC CHEMILUMINESCENT ASSAY
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$227.20
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.35
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.55
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$205.72
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$216.55
|
| Rate for Payer: United Healthcare Commercial |
$339.02
|
| Rate for Payer: United Healthcare Medicare |
$216.55
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC CHEMILUMINESCENT ASSAY
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.23 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.35
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.35
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$192.23
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$202.35
|
| Rate for Payer: United Healthcare Commercial |
$339.02
|
| Rate for Payer: United Healthcare Medicare |
$202.35
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC CHEMILUMINESCENT ASSAY - CERTOLIZUMAB ANTIBODY
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.29
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$52.53
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$55.29
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMILUMINESCENT ASSAY - CERTOLIZUMAB ANTIBODY
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$62.08
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMILUMINESCENT ASSAY - IGF BNDING PROTEIN 3
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.29
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$52.53
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$55.29
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMILUMINESCENT ASSAY - IGF BNDING PROTEIN 3
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$62.08
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMILUMINESCENT ASSAY - LEPTIN
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.14 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$113.52
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.84
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.04
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$93.14
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$98.04
|
| Rate for Payer: United Healthcare Commercial |
$164.26
|
| Rate for Payer: United Healthcare Medicare |
$98.04
|
| Rate for Payer: WINHealth Partners Commercial |
$168.56
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC CHEMILUMINESCENT ASSAY - LEPTIN
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$110.08
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.84
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.92
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$99.67
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.92
|
| Rate for Payer: United Healthcare Commercial |
$164.26
|
| Rate for Payer: United Healthcare Medicare |
$104.92
|
| Rate for Payer: WINHealth Partners Commercial |
$163.40
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC CHEMILUMINESCENT ASSAY - PARATHYROID HRM RELPEPTID
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.29
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$52.53
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$55.29
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMILUMINESCENT ASSAY - PARATHYROID HRM RELPEPTID
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
3018239705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$62.08
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
5106461601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$54.15
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicare |
$57.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 64616
|
| Hospital Charge Code |
5106461601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.95 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$64.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$57.95
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$61.00
|
| Rate for Payer: United Healthcare Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicare |
$61.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.03
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.39
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$57.37
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.39
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$60.39
|
| Rate for Payer: WINHealth Partners Commercial |
$94.05
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HC CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 64615
|
| Hospital Charge Code |
5106461501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.02
|
| Rate for Payer: Aetna of WY Medicare |
$65.34
|
| Rate for Payer: Altius Commercial |
$95.04
|
| Rate for Payer: Beech Street Commercial |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.03
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.03
|
| Rate for Payer: Cigna of WY Commercial |
$97.02
|
| Rate for Payer: Entrust Commercial |
$94.05
|
| Rate for Payer: First Choice Health Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.43
|
| Rate for Payer: HealthUtah PPO |
$99.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.03
|
| Rate for Payer: Multiplan Medicare/VA |
$53.61
|
| Rate for Payer: One Health Plan of WY PPO |
$97.02
|
| Rate for Payer: PacificSource Commercial |
$89.10
|
| Rate for Payer: PHCS PPO |
$97.02
|
| Rate for Payer: Three Rivers PPO |
$74.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.43
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$56.43
|
| Rate for Payer: WINHealth Partners Commercial |
$97.02
|
| Rate for Payer: Wise Provider Network Commercial |
$94.05
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
3359644601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$417.92
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$398.33
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$378.41
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$398.33
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$398.33
|
| Rate for Payer: WINHealth Partners Commercial |
$620.35
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC CHEMOTHERAPY, PERITONEAL CAVITY VIA INDWELLING PORT/CATHETER
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 96446
|
| Hospital Charge Code |
3359644601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$430.98
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.21
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$353.60
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.21
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$372.21
|
| Rate for Payer: WINHealth Partners Commercial |
$639.94
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$180.86 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$327.32
|
| Rate for Payer: Aetna of WY Medicare |
$220.44
|
| Rate for Payer: Altius Commercial |
$320.64
|
| Rate for Payer: Beech Street Commercial |
$327.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$323.98
|
| Rate for Payer: Cash Price |
$233.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.98
|
| Rate for Payer: Cigna of WY Commercial |
$327.32
|
| Rate for Payer: Entrust Commercial |
$317.30
|
| Rate for Payer: First Choice Health Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.38
|
| Rate for Payer: HealthUtah PPO |
$334.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.98
|
| Rate for Payer: Multiplan Medicare/VA |
$180.86
|
| Rate for Payer: One Health Plan of WY PPO |
$327.32
|
| Rate for Payer: PacificSource Commercial |
$300.60
|
| Rate for Payer: PHCS PPO |
$327.32
|
| Rate for Payer: Three Rivers PPO |
$250.50
|
| Rate for Payer: TriWest Veterans Administration |
$190.38
|
| Rate for Payer: United Healthcare Commercial |
$318.97
|
| Rate for Payer: United Healthcare Medicare |
$190.38
|
| Rate for Payer: WINHealth Partners Commercial |
$327.32
|
| Rate for Payer: Wise Provider Network Commercial |
$317.30
|
|
