|
HC FRANCISELLA TULARENSIS - TULAREMIA ANTIBODY
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86668
|
| Hospital Charge Code |
3028666801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC FRANCISELLA TULARENSIS - TULAREMIA ANTIBODY
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86668
|
| Hospital Charge Code |
3028666801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
5104152001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.06 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Aetna of WY Medicare |
$168.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.48
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$141.06
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.48
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$148.48
|
| Rate for Payer: WINHealth Partners Commercial |
$250.88
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 41520
|
| Hospital Charge Code |
5104152001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.51 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.96
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$160.51
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$168.96
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$168.96
|
| Rate for Payer: WINHealth Partners Commercial |
$243.20
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC FRESH FROZEN PLASMA-THAW
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
3008692701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$804.46 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,430.80
|
| Rate for Payer: Aetna of WY Medicare |
$963.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,401.60
|
| Rate for Payer: Altius Commercial |
$1,401.60
|
| Rate for Payer: Beech Street Commercial |
$1,430.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,198.66
|
| Rate for Payer: Cash Price |
$1,022.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,416.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,430.80
|
| Rate for Payer: Entrust Commercial |
$1,387.00
|
| Rate for Payer: First Choice Health Commercial |
$1,387.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,387.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$846.80
|
| Rate for Payer: HealthUtah PPO |
$1,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,416.20
|
| Rate for Payer: Multiplan Medicare/VA |
$804.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,430.80
|
| Rate for Payer: PacificSource Commercial |
$1,314.00
|
| Rate for Payer: PHCS PPO |
$1,430.80
|
| Rate for Payer: Three Rivers PPO |
$1,095.00
|
| Rate for Payer: TriWest Veterans Administration |
$846.80
|
| Rate for Payer: United Healthcare Commercial |
$1,270.20
|
| Rate for Payer: United Healthcare Medicare |
$846.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,430.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,387.00
|
|
|
HC FRESH FROZEN PLASMA-THAW
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
3008692701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$915.42 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,430.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,401.60
|
| Rate for Payer: Altius Commercial |
$1,401.60
|
| Rate for Payer: Beech Street Commercial |
$1,430.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,198.66
|
| Rate for Payer: Cash Price |
$1,022.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,416.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,430.80
|
| Rate for Payer: Entrust Commercial |
$1,387.00
|
| Rate for Payer: First Choice Health Commercial |
$1,387.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,387.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$963.60
|
| Rate for Payer: HealthUtah PPO |
$1,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,416.20
|
| Rate for Payer: Multiplan Medicare/VA |
$915.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,430.80
|
| Rate for Payer: PacificSource Commercial |
$1,314.00
|
| Rate for Payer: PHCS PPO |
$1,430.80
|
| Rate for Payer: Three Rivers PPO |
$1,095.00
|
| Rate for Payer: TriWest Veterans Administration |
$963.60
|
| Rate for Payer: United Healthcare Commercial |
$1,270.20
|
| Rate for Payer: United Healthcare Medicare |
$963.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,387.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,387.00
|
|
|
HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
3028667112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
3028667112
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC FUNGUS ISOLATION CULTURE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
3068710201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC FUNGUS ISOLATION CULTURE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
3068710201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC GADOLINIUM CONTRAST NOS / ML
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
255A957901
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Aetna of WY Medicare |
$3.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.90
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$2.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.90
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$2.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4.90
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC GADOLINIUM CONTRAST NOS / ML
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
255A957901
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.30
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC GARDNER VAG DNA DIR PROBE - GARDNERELLA VAGINALIS DNA PROBE, DIRECT
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
3068751001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC GARDNER VAG DNA DIR PROBE - GARDNERELLA VAGINALIS DNA PROBE, DIRECT
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
3068751001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY - NM GASTRIC EMPTYING SOLID
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS 78264
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,454.64 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,273.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,227.20
|
| Rate for Payer: Altius Commercial |
$2,227.20
|
| Rate for Payer: Beech Street Commercial |
$2,273.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,904.72
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,250.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,273.60
|
| Rate for Payer: Entrust Commercial |
$2,204.00
|
| Rate for Payer: First Choice Health Commercial |
$2,204.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,204.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,531.20
|
| Rate for Payer: HealthUtah PPO |
$2,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,250.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,454.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,273.60
|
| Rate for Payer: PacificSource Commercial |
$2,088.00
|
| Rate for Payer: PHCS PPO |
$2,273.60
|
| Rate for Payer: Three Rivers PPO |
$1,740.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,531.20
|
| Rate for Payer: United Healthcare Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare Medicare |
$1,531.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,204.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,204.00
|
|
|
HC GASTRIC EMPTYING IMAGING STUDY - NM GASTRIC EMPTYING SOLID
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS 78264
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,278.32 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,273.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,531.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,227.20
|
| Rate for Payer: Altius Commercial |
$2,227.20
|
| Rate for Payer: Beech Street Commercial |
$2,273.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,904.72
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,250.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,273.60
|
| Rate for Payer: Entrust Commercial |
$2,204.00
|
| Rate for Payer: First Choice Health Commercial |
$2,204.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,204.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,345.60
|
| Rate for Payer: HealthUtah PPO |
$2,320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,250.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,278.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,273.60
|
| Rate for Payer: PacificSource Commercial |
$2,088.00
|
| Rate for Payer: PHCS PPO |
$2,273.60
|
| Rate for Payer: Three Rivers PPO |
$1,740.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,345.60
|
| Rate for Payer: United Healthcare Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare Medicare |
$1,345.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,273.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,204.00
|
|
|
HC GATED HEART PLANAR SINGLE - NM HEART BLOOD POOL EJECT FRAC WALL MUGA
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$702.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC GATED HEART PLANAR SINGLE - NM HEART BLOOD POOL EJECT FRAC WALL MUGA
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
3018005001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
3008005001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
3018005001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC GENERAL HEALTH PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
3008005001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC GENERAL PROCEDURE
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
3600000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$862.12 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,347.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,320.00
|
| Rate for Payer: Altius Commercial |
$1,320.00
|
| Rate for Payer: Beech Street Commercial |
$1,347.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,128.88
|
| Rate for Payer: Cash Price |
$962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,333.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,347.50
|
| Rate for Payer: Entrust Commercial |
$1,306.25
|
| Rate for Payer: First Choice Health Commercial |
$1,306.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,306.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$907.50
|
| Rate for Payer: HealthUtah PPO |
$1,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,333.75
|
| Rate for Payer: Multiplan Medicare/VA |
$862.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,347.50
|
| Rate for Payer: PacificSource Commercial |
$1,237.50
|
| Rate for Payer: PHCS PPO |
$1,347.50
|
| Rate for Payer: Three Rivers PPO |
$1,031.25
|
| Rate for Payer: TriWest Veterans Administration |
$907.50
|
| Rate for Payer: United Healthcare Commercial |
$1,196.25
|
| Rate for Payer: United Healthcare Medicare |
$907.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,306.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,306.25
|
|
|
HC GENERAL PROCEDURE
|
Facility
|
OP
|
$1,375.00
|
|
| Hospital Charge Code |
3600000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$757.62 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,347.50
|
| Rate for Payer: Aetna of WY Medicare |
$907.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,320.00
|
| Rate for Payer: Altius Commercial |
$1,320.00
|
| Rate for Payer: Beech Street Commercial |
$1,347.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,128.88
|
| Rate for Payer: Cash Price |
$962.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,333.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,347.50
|
| Rate for Payer: Entrust Commercial |
$1,306.25
|
| Rate for Payer: First Choice Health Commercial |
$1,306.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,306.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$797.50
|
| Rate for Payer: HealthUtah PPO |
$1,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,333.75
|
| Rate for Payer: Multiplan Medicare/VA |
$757.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,347.50
|
| Rate for Payer: PacificSource Commercial |
$1,237.50
|
| Rate for Payer: PHCS PPO |
$1,347.50
|
| Rate for Payer: Three Rivers PPO |
$1,031.25
|
| Rate for Payer: TriWest Veterans Administration |
$797.50
|
| Rate for Payer: United Healthcare Commercial |
$1,196.25
|
| Rate for Payer: United Healthcare Medicare |
$797.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,347.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,306.25
|
|
|
HC GENOMIC SEQUENCE HEREDITARY COLON CA DSORDER
|
Facility
|
IP
|
$5,205.00
|
|
|
Service Code
|
HCPCS 81435
|
| Hospital Charge Code |
3108143501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,263.54 |
| Max. Negotiated Rate |
$5,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,100.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,996.80
|
| Rate for Payer: Altius Commercial |
$4,996.80
|
| Rate for Payer: Beech Street Commercial |
$5,100.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,273.30
|
| Rate for Payer: Cash Price |
$3,643.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,048.85
|
| Rate for Payer: Cigna of WY Commercial |
$5,100.90
|
| Rate for Payer: Entrust Commercial |
$4,944.75
|
| Rate for Payer: First Choice Health Commercial |
$4,944.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,944.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,435.30
|
| Rate for Payer: HealthUtah PPO |
$5,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,048.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3,263.54
|
| Rate for Payer: One Health Plan of WY PPO |
$5,100.90
|
| Rate for Payer: PacificSource Commercial |
$4,684.50
|
| Rate for Payer: PHCS PPO |
$5,100.90
|
| Rate for Payer: Three Rivers PPO |
$3,903.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,435.30
|
| Rate for Payer: United Healthcare Commercial |
$4,528.35
|
| Rate for Payer: United Healthcare Medicare |
$3,435.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,944.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,944.75
|
|
