|
HC LONG CHAIN FATTY ACIDS - FATTY ACIDS, LONG CHAIN
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82726
|
| Hospital Charge Code |
3018272601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| 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 |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| 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 |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC LONG TERM HOLTER, 48 HRS UP TO 7 DAYS, RECORDING
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$282.15 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$282.15
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$297.00
|
| Rate for Payer: WINHealth Partners Commercial |
$427.50
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC LONG TERM HOLTER, 48 HRS UP TO 7 DAYS, RECORDING
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Aetna of WY Medicare |
$297.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$247.95
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$261.00
|
| Rate for Payer: WINHealth Partners Commercial |
$441.00
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC LONG TERM HOLTER, MORE THAN 7 DAYS UP TO 15 DAYS, RECORDING
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 93246
|
| Hospital Charge Code |
7319324601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.44
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$21.32
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.44
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$22.44
|
| Rate for Payer: WINHealth Partners Commercial |
$32.30
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC LONG TERM HOLTER, MORE THAN 7 DAYS UP TO 15 DAYS, RECORDING
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 93246
|
| Hospital Charge Code |
7319324601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Aetna of WY Medicare |
$22.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.72
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$18.73
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$19.72
|
| Rate for Payer: WINHealth Partners Commercial |
$33.32
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC LT BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4027372303
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC LT BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4027372303
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC LUNG FUNCTION TEST (MBC/MVV) - TRANS-DIAPHRAGMATIC PRESSURE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 94200
|
| Hospital Charge Code |
4609420001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC LUNG FUNCTION TEST (MBC/MVV) - TRANS-DIAPHRAGMATIC PRESSURE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 94200
|
| Hospital Charge Code |
4609420001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$964.25 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,436.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,015.00
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$964.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,015.00
|
| Rate for Payer: United Healthcare Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare Medicare |
$1,015.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
HC LUNG PERFUSION IMAGING - NM LUNG PERFUSION PARTICULATE
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
3417858001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,097.25 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,436.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,155.00
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,097.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,155.00
|
| Rate for Payer: United Healthcare Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare Medicare |
$1,155.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL SINGLE
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL SINGLE
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$702.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION AEROSOL
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3417858202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,382.60 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,724.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,648.00
|
| Rate for Payer: Altius Commercial |
$3,648.00
|
| Rate for Payer: Beech Street Commercial |
$3,724.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,119.80
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,686.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,724.00
|
| Rate for Payer: Entrust Commercial |
$3,610.00
|
| Rate for Payer: First Choice Health Commercial |
$3,610.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,610.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,508.00
|
| Rate for Payer: HealthUtah PPO |
$3,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,686.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,382.60
|
| Rate for Payer: One Health Plan of WY PPO |
$3,724.00
|
| Rate for Payer: PacificSource Commercial |
$3,420.00
|
| Rate for Payer: PHCS PPO |
$3,724.00
|
| Rate for Payer: Three Rivers PPO |
$2,850.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,508.00
|
| Rate for Payer: United Healthcare Commercial |
$3,306.00
|
| Rate for Payer: United Healthcare Medicare |
$2,508.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,610.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,610.00
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION AEROSOL
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3417858202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,093.80 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,724.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,508.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,648.00
|
| Rate for Payer: Altius Commercial |
$3,648.00
|
| Rate for Payer: Beech Street Commercial |
$3,724.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,119.80
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,686.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,724.00
|
| Rate for Payer: Entrust Commercial |
$3,610.00
|
| Rate for Payer: First Choice Health Commercial |
$3,610.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,610.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,204.00
|
| Rate for Payer: HealthUtah PPO |
$3,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,686.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,093.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,724.00
|
| Rate for Payer: PacificSource Commercial |
$3,420.00
|
| Rate for Payer: PHCS PPO |
$3,724.00
|
| Rate for Payer: Three Rivers PPO |
$2,850.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,204.00
|
| Rate for Payer: United Healthcare Commercial |
$3,306.00
|
| Rate for Payer: United Healthcare Medicare |
$2,204.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,724.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,610.00
|
|
|
HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.10
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$107.44
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$113.10
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.70
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$128.70
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - B. BURGDORFERI ANTIBODIES WB
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3028661702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - B. BURGDORFERI ANTIBODIES WB
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3028661702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3028661701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
3028661701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPH NODE MELANOMA
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,082.72 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,296.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,139.70
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,082.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,139.70
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,139.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,925.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
|
HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPH NODE MELANOMA
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,232.06 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,296.90
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,232.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,296.90
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,296.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,866.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
|
HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPHOSCINTIGRAM
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819502
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,082.72 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,296.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,139.70
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,082.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,139.70
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,139.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,925.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
|
HC LYMPHATICS & LYMPH GLANDS IMAGING - NM LYMPHOSCINTIGRAM
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819502
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,232.06 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,296.90
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,232.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,296.90
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,296.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,866.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
