|
HC INSERT PICC W/O SUB-Q PORT W/IMAGE GUIDE >5 Y/O
|
Facility
|
OP
|
$7,330.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
7613657301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,038.83 |
| Max. Negotiated Rate |
$7,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,183.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$4,837.80
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,036.80
|
| Rate for Payer: Altius Commercial |
$7,036.80
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Beech Street Commercial |
$7,183.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,017.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$5,131.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,110.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Cigna of WY Commercial |
$7,183.40
|
| Rate for Payer: Entrust Commercial |
$6,963.50
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$6,963.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,963.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,251.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: HealthUtah PPO |
$7,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,110.10
|
| Rate for Payer: Multiplan Medicare/VA |
$4,038.83
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: One Health Plan of WY PPO |
$7,183.40
|
| Rate for Payer: PacificSource Commercial |
$6,597.00
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$7,183.40
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$5,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,251.40
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$6,377.10
|
| Rate for Payer: United Healthcare Medicare |
$4,251.40
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7,183.40
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$6,963.50
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/O IMAGE GUIDE >5 Y/O
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
5103656901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Aetna of WY Medicare |
$64.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.08
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.46
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.84
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$54.00
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.84
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$56.84
|
| Rate for Payer: WINHealth Partners Commercial |
$96.04
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/O IMAGE GUIDE >5 Y/O
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
5103656901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.08
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.46
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.68
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.68
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$64.68
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/O IMAGE GUIDE >5 Y/O
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
3203656901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC INSERT PICC W/O SUB-Q PORT W/O IMAGE GUIDE >5 Y/O
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
3203656901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
7615170201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
5105170201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
5105170201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
7615170201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
5103655701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$217.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$315.84
|
| Rate for Payer: Altius Commercial |
$315.84
|
| Rate for Payer: Beech Street Commercial |
$322.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.11
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: Entrust Commercial |
$312.55
|
| Rate for Payer: First Choice Health Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.82
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$181.28
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$322.42
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.82
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$190.82
|
| Rate for Payer: WINHealth Partners Commercial |
$322.42
|
| Rate for Payer: Wise Provider Network Commercial |
$312.55
|
|
|
HC INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
5103655701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.28 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$315.84
|
| Rate for Payer: Altius Commercial |
$315.84
|
| Rate for Payer: Beech Street Commercial |
$322.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.11
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: Entrust Commercial |
$312.55
|
| Rate for Payer: First Choice Health Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.14
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$206.28
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$322.42
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$217.14
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$217.14
|
| Rate for Payer: WINHealth Partners Commercial |
$312.55
|
| Rate for Payer: Wise Provider Network Commercial |
$312.55
|
|
|
HC INSITU HYBRIDIZATION (EG, FISH), EACH PROBE
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3128836501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$564.78 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,004.50
|
| Rate for Payer: Aetna of WY Medicare |
$676.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$984.00
|
| Rate for Payer: Altius Commercial |
$984.00
|
| Rate for Payer: Beech Street Commercial |
$1,004.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$841.52
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$994.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,004.50
|
| Rate for Payer: Entrust Commercial |
$973.75
|
| Rate for Payer: First Choice Health Commercial |
$973.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$973.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.50
|
| Rate for Payer: HealthUtah PPO |
$1,025.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$994.25
|
| Rate for Payer: Multiplan Medicare/VA |
$564.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,004.50
|
| Rate for Payer: PacificSource Commercial |
$922.50
|
| Rate for Payer: PHCS PPO |
$1,004.50
|
| Rate for Payer: Three Rivers PPO |
$768.75
|
| Rate for Payer: TriWest Veterans Administration |
$594.50
|
| Rate for Payer: United Healthcare Commercial |
$891.75
|
| Rate for Payer: United Healthcare Medicare |
$594.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,004.50
|
| Rate for Payer: Wise Provider Network Commercial |
$973.75
|
|
|
HC INSITU HYBRIDIZATION (EG, FISH), EACH PROBE
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3128836501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$642.68 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,004.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$984.00
|
| Rate for Payer: Altius Commercial |
$984.00
|
| Rate for Payer: Beech Street Commercial |
$1,004.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$841.52
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$994.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,004.50
|
| Rate for Payer: Entrust Commercial |
$973.75
|
| Rate for Payer: First Choice Health Commercial |
$973.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$973.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$676.50
|
| Rate for Payer: HealthUtah PPO |
$1,025.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$994.25
|
| Rate for Payer: Multiplan Medicare/VA |
$642.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,004.50
|
| Rate for Payer: PacificSource Commercial |
$922.50
|
| Rate for Payer: PHCS PPO |
$1,004.50
|
| Rate for Payer: Three Rivers PPO |
$768.75
|
| Rate for Payer: TriWest Veterans Administration |
$676.50
|
| Rate for Payer: United Healthcare Commercial |
$891.75
|
| Rate for Payer: United Healthcare Medicare |
$676.50
|
| Rate for Payer: WINHealth Partners Commercial |
$973.75
|
| Rate for Payer: Wise Provider Network Commercial |
$973.75
|
|
|
HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
5103655801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
5103655801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC INTRINSIC FACTOR ANTIBODY - INTRINSIC FACTOR BLOCKING ANTIBODY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
3028634001
|
|
Hospital Revenue Code
|
302
|
| 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 INTRINSIC FACTOR ANTIBODY - INTRINSIC FACTOR BLOCKING ANTIBODY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86340
|
| Hospital Charge Code |
3028634001
|
|
Hospital Revenue Code
|
302
|
| 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 INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 57180
|
| Hospital Charge Code |
5105718001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.36
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.24
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.28
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$63.92
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$67.28
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$67.28
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 57180
|
| Hospital Charge Code |
5105718001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.36
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.24
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.56
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$72.73
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$76.56
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC IODINE I-123 SOD IODIDE PER 100-999 MIC
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
343A951601
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC IODINE I-123 SOD IODIDE PER 100-999 MIC
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
343A951601
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 95940
|
| Hospital Charge Code |
9209594001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$344.38 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$612.50
|
| Rate for Payer: Aetna of WY Medicare |
$412.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$600.00
|
| Rate for Payer: Altius Commercial |
$600.00
|
| Rate for Payer: Beech Street Commercial |
$612.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$513.12
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$606.25
|
| Rate for Payer: Cigna of WY Commercial |
$612.50
|
| Rate for Payer: Entrust Commercial |
$593.75
|
| Rate for Payer: First Choice Health Commercial |
$593.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$593.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$362.50
|
| Rate for Payer: HealthUtah PPO |
$625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$606.25
|
| Rate for Payer: Multiplan Medicare/VA |
$344.38
|
| Rate for Payer: One Health Plan of WY PPO |
$612.50
|
| Rate for Payer: PacificSource Commercial |
$562.50
|
| Rate for Payer: PHCS PPO |
$612.50
|
| Rate for Payer: Three Rivers PPO |
$468.75
|
| Rate for Payer: TriWest Veterans Administration |
$362.50
|
| Rate for Payer: United Healthcare Commercial |
$543.75
|
| Rate for Payer: United Healthcare Medicare |
$362.50
|
| Rate for Payer: WINHealth Partners Commercial |
$612.50
|
| Rate for Payer: Wise Provider Network Commercial |
$593.75
|
|
|
HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 95940
|
| Hospital Charge Code |
9209594001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$391.88 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$612.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$600.00
|
| Rate for Payer: Altius Commercial |
$600.00
|
| Rate for Payer: Beech Street Commercial |
$612.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$513.12
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$606.25
|
| Rate for Payer: Cigna of WY Commercial |
$612.50
|
| Rate for Payer: Entrust Commercial |
$593.75
|
| Rate for Payer: First Choice Health Commercial |
$593.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$593.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.50
|
| Rate for Payer: HealthUtah PPO |
$625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$606.25
|
| Rate for Payer: Multiplan Medicare/VA |
$391.88
|
| Rate for Payer: One Health Plan of WY PPO |
$612.50
|
| Rate for Payer: PacificSource Commercial |
$562.50
|
| Rate for Payer: PHCS PPO |
$612.50
|
| Rate for Payer: Three Rivers PPO |
$468.75
|
| Rate for Payer: TriWest Veterans Administration |
$412.50
|
| Rate for Payer: United Healthcare Commercial |
$543.75
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
| Rate for Payer: WINHealth Partners Commercial |
$593.75
|
| Rate for Payer: Wise Provider Network Commercial |
$593.75
|
|
