|
HC CT ANGIO HRT W/3D IMAGE - CT HEART CORONARY ANGIOGRAM
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
3527557401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT LT ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$733.07 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$809.60
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,227.05
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$771.65
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$733.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$771.65
|
| Rate for Payer: United Healthcare Commercial |
$1,208.08
|
| Rate for Payer: United Healthcare Medicare |
$771.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT LT ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$685.00 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$834.90
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,227.05
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$721.05
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$685.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$721.05
|
| Rate for Payer: United Healthcare Commercial |
$1,208.08
|
| Rate for Payer: United Healthcare Medicare |
$721.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$733.07 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$809.60
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,227.05
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$771.65
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$733.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$771.65
|
| Rate for Payer: United Healthcare Commercial |
$1,208.08
|
| Rate for Payer: United Healthcare Medicare |
$771.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC CT ANGIO LWR EXTR W/O&W/DYE - CT LOWER EXT RT ANGIO W AND WO IV CONT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
3527370602
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$685.00 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$834.90
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,227.05
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$721.05
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$685.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$721.05
|
| Rate for Payer: United Healthcare Commercial |
$1,208.08
|
| Rate for Payer: United Healthcare Medicare |
$721.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
3517049801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,345.09 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,434.32
|
| Rate for Payer: Aetna of WY Medicare |
$1,639.44
|
| Rate for Payer: Altius Commercial |
$2,384.64
|
| Rate for Payer: Beech Street Commercial |
$2,434.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,409.48
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,409.48
|
| Rate for Payer: Cigna of WY Commercial |
$2,434.32
|
| Rate for Payer: Entrust Commercial |
$2,359.80
|
| Rate for Payer: First Choice Health Commercial |
$2,359.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,359.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,415.88
|
| Rate for Payer: HealthUtah PPO |
$2,484.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,409.48
|
| Rate for Payer: Multiplan Medicare/VA |
$1,345.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,434.32
|
| Rate for Payer: PacificSource Commercial |
$2,235.60
|
| Rate for Payer: PHCS PPO |
$2,434.32
|
| Rate for Payer: Three Rivers PPO |
$1,863.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,415.88
|
| Rate for Payer: United Healthcare Commercial |
$2,372.22
|
| Rate for Payer: United Healthcare Medicare |
$1,415.88
|
| Rate for Payer: WINHealth Partners Commercial |
$2,434.32
|
| Rate for Payer: Wise Provider Network Commercial |
$2,359.80
|
|
|
HC CT ANGIO,NECK COMBO - CT NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
3517049801
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,439.48 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,434.32
|
| Rate for Payer: Aetna of WY Medicare |
$1,589.76
|
| Rate for Payer: Altius Commercial |
$2,384.64
|
| Rate for Payer: Beech Street Commercial |
$2,434.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,409.48
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,409.48
|
| Rate for Payer: Cigna of WY Commercial |
$2,434.32
|
| Rate for Payer: Entrust Commercial |
$2,359.80
|
| Rate for Payer: First Choice Health Commercial |
$2,359.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,359.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,515.24
|
| Rate for Payer: HealthUtah PPO |
$2,484.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,409.48
|
| Rate for Payer: Multiplan Medicare/VA |
$1,439.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,434.32
|
| Rate for Payer: PacificSource Commercial |
$2,235.60
|
| Rate for Payer: PHCS PPO |
$2,434.32
|
| Rate for Payer: Three Rivers PPO |
$1,863.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,515.24
|
| Rate for Payer: United Healthcare Commercial |
$2,372.22
|
| Rate for Payer: United Healthcare Medicare |
$1,515.24
|
| Rate for Payer: WINHealth Partners Commercial |
$2,359.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,359.80
|
|
|
HC CT BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
OP
|
$6,649.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3505020001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,600.43 |
| Max. Negotiated Rate |
$6,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,516.02
|
| Rate for Payer: Aetna of WY Medicare |
$4,388.34
|
| Rate for Payer: Altius Commercial |
$6,383.04
|
| Rate for Payer: Beech Street Commercial |
$6,516.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,449.53
|
| Rate for Payer: Cash Price |
$4,654.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,449.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,516.02
|
| Rate for Payer: Entrust Commercial |
$6,316.55
|
| Rate for Payer: First Choice Health Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,789.93
|
| Rate for Payer: HealthUtah PPO |
$6,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,449.53
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.43
|
| Rate for Payer: One Health Plan of WY PPO |
$6,516.02
|
| Rate for Payer: PacificSource Commercial |
$5,984.10
|
| Rate for Payer: PHCS PPO |
$6,516.02
|
| Rate for Payer: Three Rivers PPO |
$4,986.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,789.93
|
| Rate for Payer: United Healthcare Commercial |
$6,349.80
|
| Rate for Payer: United Healthcare Medicare |
$3,789.93
|
| Rate for Payer: WINHealth Partners Commercial |
$6,516.02
|
| Rate for Payer: Wise Provider Network Commercial |
$6,316.55
|
|
|
HC CT BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3505020001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,853.10 |
| Max. Negotiated Rate |
$6,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,516.02
|
| Rate for Payer: Aetna of WY Medicare |
$4,255.36
|
| Rate for Payer: Altius Commercial |
$6,383.04
|
| Rate for Payer: Beech Street Commercial |
$6,516.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,449.53
|
| Rate for Payer: Cash Price |
$4,654.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,449.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,516.02
|
| Rate for Payer: Entrust Commercial |
$6,316.55
|
| Rate for Payer: First Choice Health Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,055.89
|
| Rate for Payer: HealthUtah PPO |
$6,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,449.53
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.10
|
| Rate for Payer: One Health Plan of WY PPO |
$6,516.02
|
| Rate for Payer: PacificSource Commercial |
$5,984.10
|
| Rate for Payer: PHCS PPO |
$6,516.02
|
| Rate for Payer: Three Rivers PPO |
$4,986.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,055.89
|
| Rate for Payer: United Healthcare Commercial |
$6,349.80
|
| Rate for Payer: United Healthcare Medicare |
$4,055.89
|
| Rate for Payer: WINHealth Partners Commercial |
$6,316.55
|
| Rate for Payer: Wise Provider Network Commercial |
$6,316.55
|
|
|
HC CT CHEST LOW DOSE LUNG CANCER SCREENING
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
3507127101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$474.61 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$802.62
|
| Rate for Payer: Aetna of WY Medicare |
$524.16
|
| Rate for Payer: Altius Commercial |
$786.24
|
| Rate for Payer: Beech Street Commercial |
$802.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$794.43
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$794.43
|
| Rate for Payer: Cigna of WY Commercial |
$802.62
|
| Rate for Payer: Entrust Commercial |
$778.05
|
| Rate for Payer: First Choice Health Commercial |
$778.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$778.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$499.59
|
| Rate for Payer: HealthUtah PPO |
$819.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$794.43
|
| Rate for Payer: Multiplan Medicare/VA |
$474.61
|
| Rate for Payer: One Health Plan of WY PPO |
$802.62
|
| Rate for Payer: PacificSource Commercial |
$737.10
|
| Rate for Payer: PHCS PPO |
$802.62
|
| Rate for Payer: Three Rivers PPO |
$614.25
|
| Rate for Payer: TriWest Veterans Administration |
$499.59
|
| Rate for Payer: United Healthcare Commercial |
$782.14
|
| Rate for Payer: United Healthcare Medicare |
$499.59
|
| Rate for Payer: WINHealth Partners Commercial |
$778.05
|
| Rate for Payer: Wise Provider Network Commercial |
$778.05
|
|
|
HC CT CHEST LOW DOSE LUNG CANCER SCREENING
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
3507127101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$443.49 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$802.62
|
| Rate for Payer: Aetna of WY Medicare |
$540.54
|
| Rate for Payer: Altius Commercial |
$786.24
|
| Rate for Payer: Beech Street Commercial |
$802.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$794.43
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$794.43
|
| Rate for Payer: Cigna of WY Commercial |
$802.62
|
| Rate for Payer: Entrust Commercial |
$778.05
|
| Rate for Payer: First Choice Health Commercial |
$778.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$778.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.83
|
| Rate for Payer: HealthUtah PPO |
$819.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$794.43
|
| Rate for Payer: Multiplan Medicare/VA |
$443.49
|
| Rate for Payer: One Health Plan of WY PPO |
$802.62
|
| Rate for Payer: PacificSource Commercial |
$737.10
|
| Rate for Payer: PHCS PPO |
$802.62
|
| Rate for Payer: Three Rivers PPO |
$614.25
|
| Rate for Payer: TriWest Veterans Administration |
$466.83
|
| Rate for Payer: United Healthcare Commercial |
$782.14
|
| Rate for Payer: United Healthcare Medicare |
$466.83
|
| Rate for Payer: WINHealth Partners Commercial |
$802.62
|
| Rate for Payer: Wise Provider Network Commercial |
$778.05
|
|
|
HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3507701205
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,263.32 |
| Max. Negotiated Rate |
$2,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,286.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,539.78
|
| Rate for Payer: Altius Commercial |
$2,239.68
|
| Rate for Payer: Beech Street Commercial |
$2,286.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,263.01
|
| Rate for Payer: Cash Price |
$1,633.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,263.01
|
| Rate for Payer: Cigna of WY Commercial |
$2,286.34
|
| Rate for Payer: Entrust Commercial |
$2,216.35
|
| Rate for Payer: First Choice Health Commercial |
$2,216.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,216.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,329.81
|
| Rate for Payer: HealthUtah PPO |
$2,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,263.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1,263.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,286.34
|
| Rate for Payer: PacificSource Commercial |
$2,099.70
|
| Rate for Payer: PHCS PPO |
$2,286.34
|
| Rate for Payer: Three Rivers PPO |
$1,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,329.81
|
| Rate for Payer: United Healthcare Commercial |
$2,228.02
|
| Rate for Payer: United Healthcare Medicare |
$1,329.81
|
| Rate for Payer: WINHealth Partners Commercial |
$2,286.34
|
| Rate for Payer: Wise Provider Network Commercial |
$2,216.35
|
|
|
HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
3507701205
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,351.97 |
| Max. Negotiated Rate |
$2,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,286.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,493.12
|
| Rate for Payer: Altius Commercial |
$2,239.68
|
| Rate for Payer: Beech Street Commercial |
$2,286.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,263.01
|
| Rate for Payer: Cash Price |
$1,633.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,263.01
|
| Rate for Payer: Cigna of WY Commercial |
$2,286.34
|
| Rate for Payer: Entrust Commercial |
$2,216.35
|
| Rate for Payer: First Choice Health Commercial |
$2,216.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,216.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,423.13
|
| Rate for Payer: HealthUtah PPO |
$2,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,263.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1,351.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,286.34
|
| Rate for Payer: PacificSource Commercial |
$2,099.70
|
| Rate for Payer: PHCS PPO |
$2,286.34
|
| Rate for Payer: Three Rivers PPO |
$1,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,423.13
|
| Rate for Payer: United Healthcare Commercial |
$2,228.02
|
| Rate for Payer: United Healthcare Medicare |
$1,423.13
|
| Rate for Payer: WINHealth Partners Commercial |
$2,216.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2,216.35
|
|
|
HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3527557101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$195.87 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Medicare |
$216.32
|
| Rate for Payer: Altius Commercial |
$324.48
|
| Rate for Payer: Beech Street Commercial |
$331.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.86
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: Entrust Commercial |
$321.10
|
| Rate for Payer: First Choice Health Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.18
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Multiplan Medicare/VA |
$195.87
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$331.24
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: TriWest Veterans Administration |
$206.18
|
| Rate for Payer: United Healthcare Commercial |
$322.79
|
| Rate for Payer: United Healthcare Medicare |
$206.18
|
| Rate for Payer: WINHealth Partners Commercial |
$321.10
|
| Rate for Payer: Wise Provider Network Commercial |
$321.10
|
|
|
HC CT HRT W/O DYE W/CA TEST - CT HEART CALCIUM SCORING WO CONTRAST
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
3527557101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Medicare |
$223.08
|
| Rate for Payer: Altius Commercial |
$324.48
|
| Rate for Payer: Beech Street Commercial |
$331.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.86
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: Entrust Commercial |
$321.10
|
| Rate for Payer: First Choice Health Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.66
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Multiplan Medicare/VA |
$183.03
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$331.24
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.66
|
| Rate for Payer: United Healthcare Commercial |
$322.79
|
| Rate for Payer: United Healthcare Medicare |
$192.66
|
| Rate for Payer: WINHealth Partners Commercial |
$331.24
|
| Rate for Payer: Wise Provider Network Commercial |
$321.10
|
|
|
HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
3517049201
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$979.03 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,193.28
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.56
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$979.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.56
|
| Rate for Payer: United Healthcare Medicare |
$1,030.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
3517049201
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST
|
Facility
|
IP
|
$2,603.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
3517049101
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,508.44 |
| Max. Negotiated Rate |
$2,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,550.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,665.92
|
| Rate for Payer: Altius Commercial |
$2,498.88
|
| Rate for Payer: Beech Street Commercial |
$2,550.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,524.91
|
| Rate for Payer: Cash Price |
$1,822.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,524.91
|
| Rate for Payer: Cigna of WY Commercial |
$2,550.94
|
| Rate for Payer: Entrust Commercial |
$2,472.85
|
| Rate for Payer: First Choice Health Commercial |
$2,472.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,472.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,587.83
|
| Rate for Payer: HealthUtah PPO |
$2,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,524.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1,508.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,550.94
|
| Rate for Payer: PacificSource Commercial |
$2,342.70
|
| Rate for Payer: PHCS PPO |
$2,550.94
|
| Rate for Payer: Three Rivers PPO |
$1,952.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,587.83
|
| Rate for Payer: United Healthcare Commercial |
$2,485.86
|
| Rate for Payer: United Healthcare Medicare |
$1,587.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2,472.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2,472.85
|
|
|
HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST
|
Facility
|
OP
|
$2,603.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
3517049101
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,409.52 |
| Max. Negotiated Rate |
$2,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,550.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,717.98
|
| Rate for Payer: Altius Commercial |
$2,498.88
|
| Rate for Payer: Beech Street Commercial |
$2,550.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,524.91
|
| Rate for Payer: Cash Price |
$1,822.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,524.91
|
| Rate for Payer: Cigna of WY Commercial |
$2,550.94
|
| Rate for Payer: Entrust Commercial |
$2,472.85
|
| Rate for Payer: First Choice Health Commercial |
$2,472.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,472.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,483.71
|
| Rate for Payer: HealthUtah PPO |
$2,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,524.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1,409.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,550.94
|
| Rate for Payer: PacificSource Commercial |
$2,342.70
|
| Rate for Payer: PHCS PPO |
$2,550.94
|
| Rate for Payer: Three Rivers PPO |
$1,952.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,483.71
|
| Rate for Payer: United Healthcare Commercial |
$2,485.86
|
| Rate for Payer: United Healthcare Medicare |
$1,483.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2,550.94
|
| Rate for Payer: Wise Provider Network Commercial |
$2,472.85
|
|
|
HC CT PATELLAR FX W/O MANIPULATIO
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
5102752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.50 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$152.96
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.83
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.79
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$138.50
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$145.79
|
| Rate for Payer: United Healthcare Commercial |
$228.24
|
| Rate for Payer: United Healthcare Medicare |
$145.79
|
| Rate for Payer: WINHealth Partners Commercial |
$227.05
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC CT PATELLAR FX W/O MANIPULATIO
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
5102752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$157.74
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.83
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.23
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$129.42
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.23
|
| Rate for Payer: United Healthcare Commercial |
$228.24
|
| Rate for Payer: United Healthcare Medicare |
$136.23
|
| Rate for Payer: WINHealth Partners Commercial |
$234.22
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC CT PERCUT BX, LUNG/MEDIASTINUM RIGHT
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
3203240501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,052.68 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,905.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,283.04
|
| Rate for Payer: Altius Commercial |
$1,866.24
|
| Rate for Payer: Beech Street Commercial |
$1,905.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,885.68
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,885.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,905.12
|
| Rate for Payer: Entrust Commercial |
$1,846.80
|
| Rate for Payer: First Choice Health Commercial |
$1,846.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,846.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,108.08
|
| Rate for Payer: HealthUtah PPO |
$1,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,885.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,052.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,905.12
|
| Rate for Payer: PacificSource Commercial |
$1,749.60
|
| Rate for Payer: PHCS PPO |
$1,905.12
|
| Rate for Payer: Three Rivers PPO |
$1,458.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,108.08
|
| Rate for Payer: United Healthcare Commercial |
$1,856.52
|
| Rate for Payer: United Healthcare Medicare |
$1,108.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,905.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,846.80
|
|
|
HC CT PERCUT BX, LUNG/MEDIASTINUM RIGHT
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
3203240501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,126.55 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,905.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,244.16
|
| Rate for Payer: Altius Commercial |
$1,866.24
|
| Rate for Payer: Beech Street Commercial |
$1,905.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,885.68
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,885.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,905.12
|
| Rate for Payer: Entrust Commercial |
$1,846.80
|
| Rate for Payer: First Choice Health Commercial |
$1,846.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,846.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,185.84
|
| Rate for Payer: HealthUtah PPO |
$1,944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,885.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,126.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,905.12
|
| Rate for Payer: PacificSource Commercial |
$1,749.60
|
| Rate for Payer: PHCS PPO |
$1,905.12
|
| Rate for Payer: Three Rivers PPO |
$1,458.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,185.84
|
| Rate for Payer: United Healthcare Commercial |
$1,856.52
|
| Rate for Payer: United Healthcare Medicare |
$1,185.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1,846.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,846.80
|
|
|
HC CT PERFUSION W CONTRAST
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
3500042T01
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$242.88
|
| Rate for Payer: Altius Commercial |
$353.28
|
| Rate for Payer: Beech Street Commercial |
$360.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: Entrust Commercial |
$349.60
|
| Rate for Payer: First Choice Health Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.76
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$199.27
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$360.64
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$209.76
|
| Rate for Payer: United Healthcare Commercial |
$351.44
|
| Rate for Payer: United Healthcare Medicare |
$209.76
|
| Rate for Payer: WINHealth Partners Commercial |
$360.64
|
| Rate for Payer: Wise Provider Network Commercial |
$349.60
|
|
|
HC CT PERFUSION W CONTRAST
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
3500042T01
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$235.52
|
| Rate for Payer: Altius Commercial |
$353.28
|
| Rate for Payer: Beech Street Commercial |
$360.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: Entrust Commercial |
$349.60
|
| Rate for Payer: First Choice Health Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.48
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$213.26
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$360.64
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.48
|
| Rate for Payer: United Healthcare Commercial |
$351.44
|
| Rate for Payer: United Healthcare Medicare |
$224.48
|
| Rate for Payer: WINHealth Partners Commercial |
$349.60
|
| Rate for Payer: Wise Provider Network Commercial |
$349.60
|
|
