|
HC I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 57023
|
| Hospital Charge Code |
5105702301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$573.70 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$896.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$878.40
|
| Rate for Payer: Altius Commercial |
$878.40
|
| Rate for Payer: Beech Street Commercial |
$896.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$751.22
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$887.55
|
| Rate for Payer: Cigna of WY Commercial |
$896.70
|
| Rate for Payer: Entrust Commercial |
$869.25
|
| Rate for Payer: First Choice Health Commercial |
$869.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$869.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.90
|
| Rate for Payer: HealthUtah PPO |
$915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$887.55
|
| Rate for Payer: Multiplan Medicare/VA |
$573.70
|
| Rate for Payer: One Health Plan of WY PPO |
$896.70
|
| Rate for Payer: PacificSource Commercial |
$823.50
|
| Rate for Payer: PHCS PPO |
$896.70
|
| Rate for Payer: Three Rivers PPO |
$686.25
|
| Rate for Payer: TriWest Veterans Administration |
$603.90
|
| Rate for Payer: United Healthcare Commercial |
$796.05
|
| Rate for Payer: United Healthcare Medicare |
$603.90
|
| Rate for Payer: WINHealth Partners Commercial |
$869.25
|
| Rate for Payer: Wise Provider Network Commercial |
$869.25
|
|
|
HC I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 57022
|
| Hospital Charge Code |
5105702201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.94
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$36.99
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.94
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$38.94
|
| Rate for Payer: WINHealth Partners Commercial |
$56.05
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 57022
|
| Hospital Charge Code |
5105702201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.51 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$38.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.22
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$32.51
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.22
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$34.22
|
| Rate for Payer: WINHealth Partners Commercial |
$57.82
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC I&D VULVA/PERINEAL ABSCESS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 4
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
3018278704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG 4
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
3018278704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC IGVH B CELL MUTATION ANALYSIS
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
3108126301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,197.57 |
| Max. Negotiated Rate |
$1,910.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,871.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,833.60
|
| Rate for Payer: Altius Commercial |
$1,833.60
|
| Rate for Payer: Beech Street Commercial |
$1,871.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,852.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,871.80
|
| Rate for Payer: Entrust Commercial |
$1,814.50
|
| Rate for Payer: First Choice Health Commercial |
$1,814.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,814.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,260.60
|
| Rate for Payer: HealthUtah PPO |
$1,910.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,852.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,197.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,871.80
|
| Rate for Payer: PacificSource Commercial |
$1,719.00
|
| Rate for Payer: PHCS PPO |
$1,871.80
|
| Rate for Payer: Three Rivers PPO |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,260.60
|
| Rate for Payer: United Healthcare Commercial |
$1,661.70
|
| Rate for Payer: United Healthcare Medicare |
$1,260.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,814.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,814.50
|
|
|
HC IGVH B CELL MUTATION ANALYSIS
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
3108126301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,052.41 |
| Max. Negotiated Rate |
$1,910.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,871.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,260.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,833.60
|
| Rate for Payer: Altius Commercial |
$1,833.60
|
| Rate for Payer: Beech Street Commercial |
$1,871.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,568.11
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,852.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,871.80
|
| Rate for Payer: Entrust Commercial |
$1,814.50
|
| Rate for Payer: First Choice Health Commercial |
$1,814.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,814.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,107.80
|
| Rate for Payer: HealthUtah PPO |
$1,910.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,852.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,052.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,871.80
|
| Rate for Payer: PacificSource Commercial |
$1,719.00
|
| Rate for Payer: PHCS PPO |
$1,871.80
|
| Rate for Payer: Three Rivers PPO |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,107.80
|
| Rate for Payer: United Healthcare Commercial |
$1,661.70
|
| Rate for Payer: United Healthcare Medicare |
$1,107.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,814.50
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
3504940701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,354.32 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,116.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,073.60
|
| Rate for Payer: Altius Commercial |
$2,073.60
|
| Rate for Payer: Beech Street Commercial |
$2,116.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,773.36
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,095.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,116.80
|
| Rate for Payer: Entrust Commercial |
$2,052.00
|
| Rate for Payer: First Choice Health Commercial |
$2,052.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,052.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,425.60
|
| Rate for Payer: HealthUtah PPO |
$2,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,095.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,354.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,116.80
|
| Rate for Payer: PacificSource Commercial |
$1,944.00
|
| Rate for Payer: PHCS PPO |
$2,116.80
|
| Rate for Payer: Three Rivers PPO |
$1,620.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,425.60
|
| Rate for Payer: United Healthcare Commercial |
$1,879.20
|
| Rate for Payer: United Healthcare Medicare |
$1,425.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,052.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,052.00
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
3504940701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,190.16 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,116.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,425.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,073.60
|
| Rate for Payer: Altius Commercial |
$2,073.60
|
| Rate for Payer: Beech Street Commercial |
$2,116.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,773.36
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,095.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,116.80
|
| Rate for Payer: Entrust Commercial |
$2,052.00
|
| Rate for Payer: First Choice Health Commercial |
$2,052.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,052.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,252.80
|
| Rate for Payer: HealthUtah PPO |
$2,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,095.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,190.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,116.80
|
| Rate for Payer: PacificSource Commercial |
$1,944.00
|
| Rate for Payer: PHCS PPO |
$2,116.80
|
| Rate for Payer: Three Rivers PPO |
$1,620.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,252.80
|
| Rate for Payer: United Healthcare Commercial |
$1,879.20
|
| Rate for Payer: United Healthcare Medicare |
$1,252.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,116.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,052.00
|
|
|
HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
|
Facility
|
OP
|
$14,675.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3504940501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$8,085.92 |
| Max. Negotiated Rate |
$14,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,381.50
|
| Rate for Payer: Aetna of WY Medicare |
$9,685.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,088.00
|
| Rate for Payer: Altius Commercial |
$14,088.00
|
| Rate for Payer: Beech Street Commercial |
$14,381.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,048.18
|
| Rate for Payer: Cash Price |
$10,272.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,234.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,381.50
|
| Rate for Payer: Entrust Commercial |
$13,941.25
|
| Rate for Payer: First Choice Health Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,511.50
|
| Rate for Payer: HealthUtah PPO |
$14,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,234.75
|
| Rate for Payer: Multiplan Medicare/VA |
$8,085.92
|
| Rate for Payer: One Health Plan of WY PPO |
$14,381.50
|
| Rate for Payer: PacificSource Commercial |
$13,207.50
|
| Rate for Payer: PHCS PPO |
$14,381.50
|
| Rate for Payer: Three Rivers PPO |
$11,006.25
|
| Rate for Payer: TriWest Veterans Administration |
$8,511.50
|
| Rate for Payer: United Healthcare Commercial |
$12,767.25
|
| Rate for Payer: United Healthcare Medicare |
$8,511.50
|
| Rate for Payer: WINHealth Partners Commercial |
$14,381.50
|
| Rate for Payer: Wise Provider Network Commercial |
$13,941.25
|
|
|
HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
|
Facility
|
IP
|
$14,675.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3504940501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9,201.22 |
| Max. Negotiated Rate |
$14,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,381.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,088.00
|
| Rate for Payer: Altius Commercial |
$14,088.00
|
| Rate for Payer: Beech Street Commercial |
$14,381.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,048.18
|
| Rate for Payer: Cash Price |
$10,272.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,234.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,381.50
|
| Rate for Payer: Entrust Commercial |
$13,941.25
|
| Rate for Payer: First Choice Health Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,685.50
|
| Rate for Payer: HealthUtah PPO |
$14,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,234.75
|
| Rate for Payer: Multiplan Medicare/VA |
$9,201.22
|
| Rate for Payer: One Health Plan of WY PPO |
$14,381.50
|
| Rate for Payer: PacificSource Commercial |
$13,207.50
|
| Rate for Payer: PHCS PPO |
$14,381.50
|
| Rate for Payer: Three Rivers PPO |
$11,006.25
|
| Rate for Payer: TriWest Veterans Administration |
$9,685.50
|
| Rate for Payer: United Healthcare Commercial |
$12,767.25
|
| Rate for Payer: United Healthcare Medicare |
$9,685.50
|
| Rate for Payer: WINHealth Partners Commercial |
$13,941.25
|
| Rate for Payer: Wise Provider Network Commercial |
$13,941.25
|
|
|
HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3504940601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3504940601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC IMHISTOCHEM/CYTCHM ANTIBODY EA MULTIPLEX
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$936.70 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,122.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,632.00
|
| Rate for Payer: Altius Commercial |
$1,632.00
|
| Rate for Payer: Beech Street Commercial |
$1,666.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.70
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.00
|
| Rate for Payer: Entrust Commercial |
$1,615.00
|
| Rate for Payer: First Choice Health Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.00
|
| Rate for Payer: HealthUtah PPO |
$1,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.00
|
| Rate for Payer: Multiplan Medicare/VA |
$936.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.00
|
| Rate for Payer: PacificSource Commercial |
$1,530.00
|
| Rate for Payer: PHCS PPO |
$1,666.00
|
| Rate for Payer: Three Rivers PPO |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$986.00
|
| Rate for Payer: United Healthcare Commercial |
$1,479.00
|
| Rate for Payer: United Healthcare Medicare |
$986.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,666.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,615.00
|
|
|
HC IMHISTOCHEM/CYTCHM ANTIBODY EA MULTIPLEX
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,065.90 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,632.00
|
| Rate for Payer: Altius Commercial |
$1,632.00
|
| Rate for Payer: Beech Street Commercial |
$1,666.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.70
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.00
|
| Rate for Payer: Entrust Commercial |
$1,615.00
|
| Rate for Payer: First Choice Health Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,122.00
|
| Rate for Payer: HealthUtah PPO |
$1,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,065.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.00
|
| Rate for Payer: PacificSource Commercial |
$1,530.00
|
| Rate for Payer: PHCS PPO |
$1,666.00
|
| Rate for Payer: Three Rivers PPO |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,122.00
|
| Rate for Payer: United Healthcare Commercial |
$1,479.00
|
| Rate for Payer: United Healthcare Medicare |
$1,122.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,615.00
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$719.06 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,278.90
|
| Rate for Payer: Aetna of WY Medicare |
$861.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,252.80
|
| Rate for Payer: Altius Commercial |
$1,252.80
|
| Rate for Payer: Beech Street Commercial |
$1,278.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,071.40
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,265.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,278.90
|
| Rate for Payer: Entrust Commercial |
$1,239.75
|
| Rate for Payer: First Choice Health Commercial |
$1,239.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,239.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$756.90
|
| Rate for Payer: HealthUtah PPO |
$1,305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,265.85
|
| Rate for Payer: Multiplan Medicare/VA |
$719.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,278.90
|
| Rate for Payer: PacificSource Commercial |
$1,174.50
|
| Rate for Payer: PHCS PPO |
$1,278.90
|
| Rate for Payer: Three Rivers PPO |
$978.75
|
| Rate for Payer: TriWest Veterans Administration |
$756.90
|
| Rate for Payer: United Healthcare Commercial |
$1,135.35
|
| Rate for Payer: United Healthcare Medicare |
$756.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,278.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,239.75
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3128834201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$780.62 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,220.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,195.20
|
| Rate for Payer: Altius Commercial |
$1,195.20
|
| Rate for Payer: Beech Street Commercial |
$1,220.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,022.14
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,207.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,220.10
|
| Rate for Payer: Entrust Commercial |
$1,182.75
|
| Rate for Payer: First Choice Health Commercial |
$1,182.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,182.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$821.70
|
| Rate for Payer: HealthUtah PPO |
$1,245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,207.65
|
| Rate for Payer: Multiplan Medicare/VA |
$780.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,220.10
|
| Rate for Payer: PacificSource Commercial |
$1,120.50
|
| Rate for Payer: PHCS PPO |
$1,220.10
|
| Rate for Payer: Three Rivers PPO |
$933.75
|
| Rate for Payer: TriWest Veterans Administration |
$821.70
|
| Rate for Payer: United Healthcare Commercial |
$1,083.15
|
| Rate for Payer: United Healthcare Medicare |
$821.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,182.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,182.75
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$818.24 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,278.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,252.80
|
| Rate for Payer: Altius Commercial |
$1,252.80
|
| Rate for Payer: Beech Street Commercial |
$1,278.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,071.40
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,265.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,278.90
|
| Rate for Payer: Entrust Commercial |
$1,239.75
|
| Rate for Payer: First Choice Health Commercial |
$1,239.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,239.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$861.30
|
| Rate for Payer: HealthUtah PPO |
$1,305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,265.85
|
| Rate for Payer: Multiplan Medicare/VA |
$818.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,278.90
|
| Rate for Payer: PacificSource Commercial |
$1,174.50
|
| Rate for Payer: PHCS PPO |
$1,278.90
|
| Rate for Payer: Three Rivers PPO |
$978.75
|
| Rate for Payer: TriWest Veterans Administration |
$861.30
|
| Rate for Payer: United Healthcare Commercial |
$1,135.35
|
| Rate for Payer: United Healthcare Medicare |
$861.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,239.75
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3128834201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,220.10
|
| Rate for Payer: Aetna of WY Medicare |
$821.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,195.20
|
| Rate for Payer: Altius Commercial |
$1,195.20
|
| Rate for Payer: Beech Street Commercial |
$1,220.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,022.14
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,207.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,220.10
|
| Rate for Payer: Entrust Commercial |
$1,182.75
|
| Rate for Payer: First Choice Health Commercial |
$1,182.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,182.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$722.10
|
| Rate for Payer: HealthUtah PPO |
$1,245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,207.65
|
| Rate for Payer: Multiplan Medicare/VA |
$686.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,220.10
|
| Rate for Payer: PacificSource Commercial |
$1,120.50
|
| Rate for Payer: PHCS PPO |
$1,220.10
|
| Rate for Payer: Three Rivers PPO |
$933.75
|
| Rate for Payer: TriWest Veterans Administration |
$722.10
|
| Rate for Payer: United Healthcare Commercial |
$1,083.15
|
| Rate for Payer: United Healthcare Medicare |
$722.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,220.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,182.75
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - CD19 ABSOLUTE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3038635603
|
|
Hospital Revenue Code
|
303
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - CD19 ABSOLUTE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3038635603
|
|
Hospital Revenue Code
|
303
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - CD3
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3028635602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.90
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$291.56
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.90
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$306.90
|
| Rate for Payer: WINHealth Partners Commercial |
$441.75
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - CD3
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3028635602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$256.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Aetna of WY Medicare |
$306.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.70
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$256.22
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$269.70
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$269.70
|
| Rate for Payer: WINHealth Partners Commercial |
$455.70
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
