|
HC LEGIONELLA, DNA, AMP PROBE - LEGIONELLA DNA BY PCR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
3068754101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC LEGIONELLA, DNA, AMP PROBE - LEGIONELLA DNA BY PCR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
3068754101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC LEGIONELLA - LEGIONELLA PNEUMOPHILA TOTL AB
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86713
|
| Hospital Charge Code |
3028671301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC LEGIONELLA - LEGIONELLA PNEUMOPHILA TOTL AB
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86713
|
| Hospital Charge Code |
3028671301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC LEVEL 3 ADDITIONAL PROCEDURE
|
Facility
|
IP
|
$1,085.00
|
|
| Hospital Charge Code |
3600000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.30 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,041.60
|
| Rate for Payer: Altius Commercial |
$1,041.60
|
| Rate for Payer: Beech Street Commercial |
$1,063.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$890.78
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: Entrust Commercial |
$1,030.75
|
| Rate for Payer: First Choice Health Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$716.10
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$680.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,063.30
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$716.10
|
| Rate for Payer: United Healthcare Commercial |
$943.95
|
| Rate for Payer: United Healthcare Medicare |
$716.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,030.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,030.75
|
|
|
HC LEVEL 3 ADDITIONAL PROCEDURE
|
Facility
|
OP
|
$1,085.00
|
|
| Hospital Charge Code |
3600000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.84 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Aetna of WY Medicare |
$716.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,041.60
|
| Rate for Payer: Altius Commercial |
$1,041.60
|
| Rate for Payer: Beech Street Commercial |
$1,063.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$890.78
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: Entrust Commercial |
$1,030.75
|
| Rate for Payer: First Choice Health Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$629.30
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$597.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,063.30
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$629.30
|
| Rate for Payer: United Healthcare Commercial |
$943.95
|
| Rate for Payer: United Healthcare Medicare |
$629.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,030.75
|
|
|
HC LIPID PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
3018006101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC LIPID PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
3018006101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
3018370401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.60
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$176.32
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.60
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$185.60
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
3018370401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$200.64
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.20
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$211.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC LIPOPROTEIN BLOOD, HIGH RES FRACTION/ QUANT - LIPOPROTEIN SUBCLASS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 83701
|
| Hospital Charge Code |
3018370101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC LIPOPROTEIN BLOOD, HIGH RES FRACTION/ QUANT - LIPOPROTEIN SUBCLASS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 83701
|
| Hospital Charge Code |
3018370101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC LITHO FLUORO
|
Facility
|
OP
|
$2,800.00
|
|
| Hospital Charge Code |
3600000027
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,542.80 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,848.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,624.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,624.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,624.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,744.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC LITHO FLUORO
|
Facility
|
IP
|
$2,800.00
|
|
| Hospital Charge Code |
3600000027
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,755.60 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,744.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$2,688.00
|
| Rate for Payer: Beech Street Commercial |
$2,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,298.80
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,716.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,744.00
|
| Rate for Payer: Entrust Commercial |
$2,660.00
|
| Rate for Payer: First Choice Health Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,660.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,848.00
|
| Rate for Payer: HealthUtah PPO |
$2,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,716.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,755.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,744.00
|
| Rate for Payer: PacificSource Commercial |
$2,520.00
|
| Rate for Payer: PHCS PPO |
$2,744.00
|
| Rate for Payer: Three Rivers PPO |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,848.00
|
| Rate for Payer: United Healthcare Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare Medicare |
$1,848.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,660.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,660.00
|
|
|
HC LITHOTRIPSY PROCEDURE
|
Facility
|
IP
|
$13,065.00
|
|
| Hospital Charge Code |
3600000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,191.76 |
| Max. Negotiated Rate |
$13,065.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,803.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,542.40
|
| Rate for Payer: Altius Commercial |
$12,542.40
|
| Rate for Payer: Beech Street Commercial |
$12,803.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,726.36
|
| Rate for Payer: Cash Price |
$9,145.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,673.05
|
| Rate for Payer: Cigna of WY Commercial |
$12,803.70
|
| Rate for Payer: Entrust Commercial |
$12,411.75
|
| Rate for Payer: First Choice Health Commercial |
$12,411.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,411.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,622.90
|
| Rate for Payer: HealthUtah PPO |
$13,065.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,673.05
|
| Rate for Payer: Multiplan Medicare/VA |
$8,191.76
|
| Rate for Payer: One Health Plan of WY PPO |
$12,803.70
|
| Rate for Payer: PacificSource Commercial |
$11,758.50
|
| Rate for Payer: PHCS PPO |
$12,803.70
|
| Rate for Payer: Three Rivers PPO |
$9,798.75
|
| Rate for Payer: TriWest Veterans Administration |
$8,622.90
|
| Rate for Payer: United Healthcare Commercial |
$11,366.55
|
| Rate for Payer: United Healthcare Medicare |
$8,622.90
|
| Rate for Payer: WINHealth Partners Commercial |
$12,411.75
|
| Rate for Payer: Wise Provider Network Commercial |
$12,411.75
|
|
|
HC LITHOTRIPSY PROCEDURE
|
Facility
|
OP
|
$13,065.00
|
|
| Hospital Charge Code |
3600000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,198.82 |
| Max. Negotiated Rate |
$13,065.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12,803.70
|
| Rate for Payer: Aetna of WY Medicare |
$8,622.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,542.40
|
| Rate for Payer: Altius Commercial |
$12,542.40
|
| Rate for Payer: Beech Street Commercial |
$12,803.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,726.36
|
| Rate for Payer: Cash Price |
$9,145.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,673.05
|
| Rate for Payer: Cigna of WY Commercial |
$12,803.70
|
| Rate for Payer: Entrust Commercial |
$12,411.75
|
| Rate for Payer: First Choice Health Commercial |
$12,411.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,411.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,577.70
|
| Rate for Payer: HealthUtah PPO |
$13,065.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,673.05
|
| Rate for Payer: Multiplan Medicare/VA |
$7,198.82
|
| Rate for Payer: One Health Plan of WY PPO |
$12,803.70
|
| Rate for Payer: PacificSource Commercial |
$11,758.50
|
| Rate for Payer: PHCS PPO |
$12,803.70
|
| Rate for Payer: Three Rivers PPO |
$9,798.75
|
| Rate for Payer: TriWest Veterans Administration |
$7,577.70
|
| Rate for Payer: United Healthcare Commercial |
$11,366.55
|
| Rate for Payer: United Healthcare Medicare |
$7,577.70
|
| Rate for Payer: WINHealth Partners Commercial |
$12,803.70
|
| Rate for Payer: Wise Provider Network Commercial |
$12,411.75
|
|
|
HC LOC INFLAMMATORY PROCESS
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
3497883001
|
|
Hospital Revenue Code
|
349
|
| Min. Negotiated Rate |
$2,135.12 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,797.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,557.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,720.00
|
| Rate for Payer: Altius Commercial |
$3,720.00
|
| Rate for Payer: Beech Street Commercial |
$3,797.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,181.38
|
| Rate for Payer: Cash Price |
$2,712.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,758.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,797.50
|
| Rate for Payer: Entrust Commercial |
$3,681.25
|
| Rate for Payer: First Choice Health Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,247.50
|
| Rate for Payer: HealthUtah PPO |
$3,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,758.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,135.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,797.50
|
| Rate for Payer: PacificSource Commercial |
$3,487.50
|
| Rate for Payer: PHCS PPO |
$3,797.50
|
| Rate for Payer: Three Rivers PPO |
$2,906.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,247.50
|
| Rate for Payer: United Healthcare Commercial |
$3,371.25
|
| Rate for Payer: United Healthcare Medicare |
$2,247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,797.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,681.25
|
|
|
HC LOC INFLAMMATORY PROCESS
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
3497883001
|
|
Hospital Revenue Code
|
349
|
| Min. Negotiated Rate |
$2,429.62 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,797.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,720.00
|
| Rate for Payer: Altius Commercial |
$3,720.00
|
| Rate for Payer: Beech Street Commercial |
$3,797.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,181.38
|
| Rate for Payer: Cash Price |
$2,712.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,758.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,797.50
|
| Rate for Payer: Entrust Commercial |
$3,681.25
|
| Rate for Payer: First Choice Health Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,557.50
|
| Rate for Payer: HealthUtah PPO |
$3,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,758.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,429.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,797.50
|
| Rate for Payer: PacificSource Commercial |
$3,487.50
|
| Rate for Payer: PHCS PPO |
$3,797.50
|
| Rate for Payer: Three Rivers PPO |
$2,906.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,557.50
|
| Rate for Payer: United Healthcare Commercial |
$3,371.25
|
| Rate for Payer: United Healthcare Medicare |
$2,557.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,681.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,681.25
|
|
|
HC LOCM 100-199MG/ML IODINE, PER ML
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
255Q996501
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Aetna of WY Medicare |
$3.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.90
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$2.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.90
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$2.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4.90
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC LOCM 100-199MG/ML IODINE, PER ML
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
255Q996501
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.30
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC LOCM 200-299MG/ML IODINE, PER ML
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
255Q996601
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Aetna of WY Medicare |
$15.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.92
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.22
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.92
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicare |
$13.92
|
| Rate for Payer: WINHealth Partners Commercial |
$23.52
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
|
|
HC LOCM 200-299MG/ML IODINE, PER ML
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
255Q996601
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.04
|
| Rate for Payer: Altius Commercial |
$23.04
|
| Rate for Payer: Beech Street Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.28
|
| Rate for Payer: Cigna of WY Commercial |
$23.52
|
| Rate for Payer: Entrust Commercial |
$22.80
|
| Rate for Payer: First Choice Health Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.84
|
| Rate for Payer: HealthUtah PPO |
$24.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.28
|
| Rate for Payer: Multiplan Medicare/VA |
$15.05
|
| Rate for Payer: One Health Plan of WY PPO |
$23.52
|
| Rate for Payer: PacificSource Commercial |
$21.60
|
| Rate for Payer: PHCS PPO |
$23.52
|
| Rate for Payer: Three Rivers PPO |
$18.00
|
| Rate for Payer: TriWest Veterans Administration |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicare |
$15.84
|
| Rate for Payer: WINHealth Partners Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$22.80
|
|
|
HC LOCM 300-399MG/ML IODINE, PER ML
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
255Q996701
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Aetna of WY Medicare |
$2.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.84
|
| Rate for Payer: Altius Commercial |
$3.84
|
| Rate for Payer: Beech Street Commercial |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: Entrust Commercial |
$3.80
|
| Rate for Payer: First Choice Health Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.32
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.92
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$2.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3.80
|
|
|
HC LOCM 300-399MG/ML IODINE, PER ML
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
255Q996701
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.84
|
| Rate for Payer: Altius Commercial |
$3.84
|
| Rate for Payer: Beech Street Commercial |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: Entrust Commercial |
$3.80
|
| Rate for Payer: First Choice Health Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.64
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2.51
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.92
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$2.64
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$2.64
|
| Rate for Payer: WINHealth Partners Commercial |
$3.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3.80
|
|
|
HC LONG CHAIN FATTY ACIDS - FATTY ACIDS, LONG CHAIN
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82726
|
| Hospital Charge Code |
3018272601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
