|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 7
|
Facility
|
OP
|
$2,525.00
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
3008140602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,391.28 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,474.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,666.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,424.00
|
| Rate for Payer: Altius Commercial |
$2,424.00
|
| Rate for Payer: Beech Street Commercial |
$2,474.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,073.02
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,449.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,474.50
|
| Rate for Payer: Entrust Commercial |
$2,398.75
|
| Rate for Payer: First Choice Health Commercial |
$2,398.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,398.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,464.50
|
| Rate for Payer: HealthUtah PPO |
$2,525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,449.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,391.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,474.50
|
| Rate for Payer: PacificSource Commercial |
$2,272.50
|
| Rate for Payer: PHCS PPO |
$2,474.50
|
| Rate for Payer: Three Rivers PPO |
$1,893.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,464.50
|
| Rate for Payer: United Healthcare Commercial |
$2,196.75
|
| Rate for Payer: United Healthcare Medicare |
$1,464.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,474.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,398.75
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 7
|
Facility
|
IP
|
$2,525.00
|
|
|
Service Code
|
HCPCS 81406
|
| Hospital Charge Code |
3008140602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,583.18 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,474.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,424.00
|
| Rate for Payer: Altius Commercial |
$2,424.00
|
| Rate for Payer: Beech Street Commercial |
$2,474.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,073.02
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,449.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,474.50
|
| Rate for Payer: Entrust Commercial |
$2,398.75
|
| Rate for Payer: First Choice Health Commercial |
$2,398.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,398.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,666.50
|
| Rate for Payer: HealthUtah PPO |
$2,525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,449.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,583.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,474.50
|
| Rate for Payer: PacificSource Commercial |
$2,272.50
|
| Rate for Payer: PHCS PPO |
$2,474.50
|
| Rate for Payer: Three Rivers PPO |
$1,893.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,666.50
|
| Rate for Payer: United Healthcare Commercial |
$2,196.75
|
| Rate for Payer: United Healthcare Medicare |
$1,666.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,398.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,398.75
|
|
|
HC MONONUCLEAR CELL ANITGEN NOS
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3028635601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$293.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.10
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$245.20
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$258.10
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$258.10
|
| Rate for Payer: WINHealth Partners Commercial |
$436.10
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC MONONUCLEAR CELL ANITGEN NOS
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 86356
|
| Hospital Charge Code |
3028635601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.70
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$279.02
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$293.70
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$293.70
|
| Rate for Payer: WINHealth Partners Commercial |
$422.75
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC MORPHOMETRIC ANALYSIS (FISH) SINGLE
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 88369
|
| Hospital Charge Code |
3128836902
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$429.78 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Aetna of WY Medicare |
$514.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.40
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$429.78
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$452.40
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$452.40
|
| Rate for Payer: WINHealth Partners Commercial |
$764.40
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC MORPHOMETRIC ANALYSIS (FISH) SINGLE
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 88369
|
| Hospital Charge Code |
3128836902
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$489.06 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.80
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$489.06
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$514.80
|
| Rate for Payer: WINHealth Partners Commercial |
$741.00
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC MORPHOMETRIC ANALYSIS,TUMOR IMMUNOHISTOCHEMISTRY, EA ANTIBODY MANUAL
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
3128836001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$352.64 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$371.20
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC MORPHOMETRIC ANALYSIS,TUMOR IMMUNOHISTOCHEMISTRY, EA ANTIBODY MANUAL
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
3128836001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB - HER-2 / NEU, FISH
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
3128837701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$534.47 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Aetna of WY Medicare |
$640.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.60
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$534.47
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.60
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$562.60
|
| Rate for Payer: WINHealth Partners Commercial |
$950.60
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB - HER-2 / NEU, FISH
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
3128837701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$608.19 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.20
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$608.19
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$640.20
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$640.20
|
| Rate for Payer: WINHealth Partners Commercial |
$921.50
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC M.PNEUMON, DNA, AMP PROBE - MYCOPLASMA PNEUMONIAE PCR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
3068758101
|
|
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 M.PNEUMON, DNA, AMP PROBE - MYCOPLASMA PNEUMONIAE PCR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
3068758101
|
|
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 MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$2,370.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418501
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,305.87 |
| Max. Negotiated Rate |
$2,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,322.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,564.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,275.20
|
| Rate for Payer: Altius Commercial |
$2,275.20
|
| Rate for Payer: Beech Street Commercial |
$2,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,945.77
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,298.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,322.60
|
| Rate for Payer: Entrust Commercial |
$2,251.50
|
| Rate for Payer: First Choice Health Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,374.60
|
| Rate for Payer: HealthUtah PPO |
$2,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,298.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,305.87
|
| Rate for Payer: One Health Plan of WY PPO |
$2,322.60
|
| Rate for Payer: PacificSource Commercial |
$2,133.00
|
| Rate for Payer: PHCS PPO |
$2,322.60
|
| Rate for Payer: Three Rivers PPO |
$1,777.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,374.60
|
| Rate for Payer: United Healthcare Commercial |
$2,061.90
|
| Rate for Payer: United Healthcare Medicare |
$1,374.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,322.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,251.50
|
|
|
HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$2,370.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418501
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,322.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,275.20
|
| Rate for Payer: Altius Commercial |
$2,275.20
|
| Rate for Payer: Beech Street Commercial |
$2,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,945.77
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,298.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,322.60
|
| Rate for Payer: Entrust Commercial |
$2,251.50
|
| Rate for Payer: First Choice Health Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,564.20
|
| Rate for Payer: HealthUtah PPO |
$2,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,298.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,485.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,322.60
|
| Rate for Payer: PacificSource Commercial |
$2,133.00
|
| Rate for Payer: PHCS PPO |
$2,322.60
|
| Rate for Payer: Three Rivers PPO |
$1,777.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,564.20
|
| Rate for Payer: United Healthcare Commercial |
$2,061.90
|
| Rate for Payer: United Healthcare Medicare |
$1,564.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,251.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,251.50
|
|
|
HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W IV CONTRAST
|
Facility
|
IP
|
$2,370.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418502
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,322.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,275.20
|
| Rate for Payer: Altius Commercial |
$2,275.20
|
| Rate for Payer: Beech Street Commercial |
$2,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,945.77
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,298.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,322.60
|
| Rate for Payer: Entrust Commercial |
$2,251.50
|
| Rate for Payer: First Choice Health Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,564.20
|
| Rate for Payer: HealthUtah PPO |
$2,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,298.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,485.99
|
| Rate for Payer: One Health Plan of WY PPO |
$2,322.60
|
| Rate for Payer: PacificSource Commercial |
$2,133.00
|
| Rate for Payer: PHCS PPO |
$2,322.60
|
| Rate for Payer: Three Rivers PPO |
$1,777.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,564.20
|
| Rate for Payer: United Healthcare Commercial |
$2,061.90
|
| Rate for Payer: United Healthcare Medicare |
$1,564.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,251.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,251.50
|
|
|
HC MR ANGIO ABDOMEN (MRA) - MR ABDOMEN ANGIO W IV CONTRAST
|
Facility
|
OP
|
$2,370.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418502
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,305.87 |
| Max. Negotiated Rate |
$2,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,322.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,564.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,275.20
|
| Rate for Payer: Altius Commercial |
$2,275.20
|
| Rate for Payer: Beech Street Commercial |
$2,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,945.77
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,298.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,322.60
|
| Rate for Payer: Entrust Commercial |
$2,251.50
|
| Rate for Payer: First Choice Health Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,251.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,374.60
|
| Rate for Payer: HealthUtah PPO |
$2,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,298.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,305.87
|
| Rate for Payer: One Health Plan of WY PPO |
$2,322.60
|
| Rate for Payer: PacificSource Commercial |
$2,133.00
|
| Rate for Payer: PHCS PPO |
$2,322.60
|
| Rate for Payer: Three Rivers PPO |
$1,777.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,374.60
|
| Rate for Payer: United Healthcare Commercial |
$2,061.90
|
| Rate for Payer: United Healthcare Medicare |
$1,374.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,322.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,251.50
|
|
|
HC MR ANGIO, HEAD, COMBO - MR HEAD ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
6157054601
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,873.40 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,332.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,244.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,264.00
|
| Rate for Payer: Altius Commercial |
$3,264.00
|
| Rate for Payer: Beech Street Commercial |
$3,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,791.40
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,298.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,332.00
|
| Rate for Payer: Entrust Commercial |
$3,230.00
|
| Rate for Payer: First Choice Health Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,972.00
|
| Rate for Payer: HealthUtah PPO |
$3,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,298.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,873.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,332.00
|
| Rate for Payer: PacificSource Commercial |
$3,060.00
|
| Rate for Payer: PHCS PPO |
$3,332.00
|
| Rate for Payer: Three Rivers PPO |
$2,550.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,972.00
|
| Rate for Payer: United Healthcare Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare Medicare |
$1,972.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,332.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,230.00
|
|
|
HC MR ANGIO, HEAD, COMBO - MR HEAD ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
6157054601
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,131.80 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,332.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,264.00
|
| Rate for Payer: Altius Commercial |
$3,264.00
|
| Rate for Payer: Beech Street Commercial |
$3,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,791.40
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,298.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,332.00
|
| Rate for Payer: Entrust Commercial |
$3,230.00
|
| Rate for Payer: First Choice Health Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,244.00
|
| Rate for Payer: HealthUtah PPO |
$3,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,298.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,131.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,332.00
|
| Rate for Payer: PacificSource Commercial |
$3,060.00
|
| Rate for Payer: PHCS PPO |
$3,332.00
|
| Rate for Payer: Three Rivers PPO |
$2,550.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare Medicare |
$2,244.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,230.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,230.00
|
|
|
HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
6157054401
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,567.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,650.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,375.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC MR ANGIO, HEAD - MR HEAD ANGIO WO IV CONTRAST
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
6157054401
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,377.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,650.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,377.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,450.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC MR ANGIO, HEAD W/CONTRAST - MR HEAD ANGIO W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
6157054501
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MR ANGIO, HEAD W/CONTRAST - MR HEAD ANGIO W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 70545
|
| Hospital Charge Code |
6157054501
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W IV CONT LT
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
6167372507
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,479.72 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,312.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,265.60
|
| Rate for Payer: Altius Commercial |
$2,265.60
|
| Rate for Payer: Beech Street Commercial |
$2,312.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,937.56
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,289.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,312.80
|
| Rate for Payer: Entrust Commercial |
$2,242.00
|
| Rate for Payer: First Choice Health Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,557.60
|
| Rate for Payer: HealthUtah PPO |
$2,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,289.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,479.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,312.80
|
| Rate for Payer: PacificSource Commercial |
$2,124.00
|
| Rate for Payer: PHCS PPO |
$2,312.80
|
| Rate for Payer: Three Rivers PPO |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,557.60
|
| Rate for Payer: United Healthcare Commercial |
$2,053.20
|
| Rate for Payer: United Healthcare Medicare |
$1,557.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,242.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,242.00
|
|
|
HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W IV CONT LT
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
6167372507
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,300.36 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,312.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,557.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,265.60
|
| Rate for Payer: Altius Commercial |
$2,265.60
|
| Rate for Payer: Beech Street Commercial |
$2,312.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,937.56
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,289.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,312.80
|
| Rate for Payer: Entrust Commercial |
$2,242.00
|
| Rate for Payer: First Choice Health Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,368.80
|
| Rate for Payer: HealthUtah PPO |
$2,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,289.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,300.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,312.80
|
| Rate for Payer: PacificSource Commercial |
$2,124.00
|
| Rate for Payer: PHCS PPO |
$2,312.80
|
| Rate for Payer: Three Rivers PPO |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,368.80
|
| Rate for Payer: United Healthcare Commercial |
$2,053.20
|
| Rate for Payer: United Healthcare Medicare |
$1,368.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,312.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,242.00
|
|
|
HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W IV CONT RT
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
6167372505
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,300.36 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,312.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,557.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,265.60
|
| Rate for Payer: Altius Commercial |
$2,265.60
|
| Rate for Payer: Beech Street Commercial |
$2,312.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,937.56
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,289.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,312.80
|
| Rate for Payer: Entrust Commercial |
$2,242.00
|
| Rate for Payer: First Choice Health Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,368.80
|
| Rate for Payer: HealthUtah PPO |
$2,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,289.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,300.36
|
| Rate for Payer: One Health Plan of WY PPO |
$2,312.80
|
| Rate for Payer: PacificSource Commercial |
$2,124.00
|
| Rate for Payer: PHCS PPO |
$2,312.80
|
| Rate for Payer: Three Rivers PPO |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,368.80
|
| Rate for Payer: United Healthcare Commercial |
$2,053.20
|
| Rate for Payer: United Healthcare Medicare |
$1,368.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,312.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,242.00
|
|
