|
HC PBB OFFICE OUTPATIENT VISIT 10 MINUTES
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
5109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.96
|
| Rate for Payer: Altius Commercial |
$24.96
|
| Rate for Payer: Beech Street Commercial |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.35
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.22
|
| Rate for Payer: Cigna of WY Commercial |
$25.48
|
| Rate for Payer: Entrust Commercial |
$24.70
|
| Rate for Payer: First Choice Health Commercial |
$24.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.16
|
| Rate for Payer: HealthUtah PPO |
$26.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.22
|
| Rate for Payer: Multiplan Medicare/VA |
$16.30
|
| Rate for Payer: One Health Plan of WY PPO |
$25.48
|
| Rate for Payer: PacificSource Commercial |
$23.40
|
| Rate for Payer: PHCS PPO |
$25.48
|
| Rate for Payer: Three Rivers PPO |
$19.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.16
|
| Rate for Payer: United Healthcare Commercial |
$22.62
|
| Rate for Payer: United Healthcare Medicare |
$17.16
|
| Rate for Payer: WINHealth Partners Commercial |
$24.70
|
| Rate for Payer: Wise Provider Network Commercial |
$24.70
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 20-29 MINUTES
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
5109921301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$63.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 20-29 MINUTES
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
5109921301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.78
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.69
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.78
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$21.78
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 30-39 MINUTES
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
5109921401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.68
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.10
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.68
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$31.68
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 30-39 MINUTES
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
5109921401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$99.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.84
|
| Rate for Payer: HealthUtah PPO |
$99.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$26.45
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.84
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$27.84
|
| Rate for Payer: WINHealth Partners Commercial |
$47.04
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
5109921501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$146.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$53.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.98
|
| Rate for Payer: HealthUtah PPO |
$146.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$44.63
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$46.98
|
| Rate for Payer: WINHealth Partners Commercial |
$79.38
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC PBB OFFICE OUTPATIENT VISIT EST 40-54 MINUTES
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
5109921501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.46
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$50.79
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.46
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$53.46
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC PBB TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
5109949601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.71 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$106.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.38
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$88.71
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.38
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$93.38
|
| Rate for Payer: WINHealth Partners Commercial |
$157.78
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC PBB TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 99496
|
| Hospital Charge Code |
5109949601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.26
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$100.95
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.26
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$106.26
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
5105741001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.72
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.85
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.62
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$67.09
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.62
|
| Rate for Payer: United Healthcare Commercial |
$93.09
|
| Rate for Payer: United Healthcare Medicare |
$70.62
|
| Rate for Payer: WINHealth Partners Commercial |
$101.65
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
5105741001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$70.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.72
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.85
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.06
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$58.96
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.06
|
| Rate for Payer: United Healthcare Commercial |
$93.09
|
| Rate for Payer: United Healthcare Medicare |
$62.06
|
| Rate for Payer: WINHealth Partners Commercial |
$104.86
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC PENTAMIDINE AEROSOL INHALATION TREATMENT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
4109464201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$253.94 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$396.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$388.80
|
| Rate for Payer: Altius Commercial |
$388.80
|
| Rate for Payer: Beech Street Commercial |
$396.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$392.85
|
| Rate for Payer: Cigna of WY Commercial |
$396.90
|
| Rate for Payer: Entrust Commercial |
$384.75
|
| Rate for Payer: First Choice Health Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.30
|
| Rate for Payer: HealthUtah PPO |
$405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$392.85
|
| Rate for Payer: Multiplan Medicare/VA |
$253.94
|
| Rate for Payer: One Health Plan of WY PPO |
$396.90
|
| Rate for Payer: PacificSource Commercial |
$364.50
|
| Rate for Payer: PHCS PPO |
$396.90
|
| Rate for Payer: Three Rivers PPO |
$303.75
|
| Rate for Payer: TriWest Veterans Administration |
$267.30
|
| Rate for Payer: United Healthcare Commercial |
$352.35
|
| Rate for Payer: United Healthcare Medicare |
$267.30
|
| Rate for Payer: WINHealth Partners Commercial |
$384.75
|
| Rate for Payer: Wise Provider Network Commercial |
$384.75
|
|
|
HC PENTAMIDINE AEROSOL INHALATION TREATMENT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
4109464201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$223.16 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$396.90
|
| Rate for Payer: Aetna of WY Medicare |
$267.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$388.80
|
| Rate for Payer: Altius Commercial |
$388.80
|
| Rate for Payer: Beech Street Commercial |
$396.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$392.85
|
| Rate for Payer: Cigna of WY Commercial |
$396.90
|
| Rate for Payer: Entrust Commercial |
$384.75
|
| Rate for Payer: First Choice Health Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$384.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.90
|
| Rate for Payer: HealthUtah PPO |
$405.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$392.85
|
| Rate for Payer: Multiplan Medicare/VA |
$223.16
|
| Rate for Payer: One Health Plan of WY PPO |
$396.90
|
| Rate for Payer: PacificSource Commercial |
$364.50
|
| Rate for Payer: PHCS PPO |
$396.90
|
| Rate for Payer: Three Rivers PPO |
$303.75
|
| Rate for Payer: TriWest Veterans Administration |
$234.90
|
| Rate for Payer: United Healthcare Commercial |
$352.35
|
| Rate for Payer: United Healthcare Medicare |
$234.90
|
| Rate for Payer: WINHealth Partners Commercial |
$396.90
|
| Rate for Payer: Wise Provider Network Commercial |
$384.75
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3504918001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3504918001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3204918001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
3204918001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
4024918001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERCUT BIOPSY, ABDOMINAL MASS
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
4024918001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
OP
|
$3,030.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
4027706501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,669.53 |
| Max. Negotiated Rate |
$3,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,969.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,999.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,908.80
|
| Rate for Payer: Altius Commercial |
$2,908.80
|
| Rate for Payer: Beech Street Commercial |
$2,969.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,487.63
|
| Rate for Payer: Cash Price |
$2,121.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,939.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,969.40
|
| Rate for Payer: Entrust Commercial |
$2,878.50
|
| Rate for Payer: First Choice Health Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,757.40
|
| Rate for Payer: HealthUtah PPO |
$3,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,939.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,669.53
|
| Rate for Payer: One Health Plan of WY PPO |
$2,969.40
|
| Rate for Payer: PacificSource Commercial |
$2,727.00
|
| Rate for Payer: PHCS PPO |
$2,969.40
|
| Rate for Payer: Three Rivers PPO |
$2,272.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,757.40
|
| Rate for Payer: United Healthcare Commercial |
$2,636.10
|
| Rate for Payer: United Healthcare Medicare |
$1,757.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,969.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,878.50
|
|
|
HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
IP
|
$3,030.00
|
|
|
Service Code
|
HCPCS 77065
|
| Hospital Charge Code |
4027706501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,899.81 |
| Max. Negotiated Rate |
$3,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,969.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,908.80
|
| Rate for Payer: Altius Commercial |
$2,908.80
|
| Rate for Payer: Beech Street Commercial |
$2,969.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,487.63
|
| Rate for Payer: Cash Price |
$2,121.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,939.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,969.40
|
| Rate for Payer: Entrust Commercial |
$2,878.50
|
| Rate for Payer: First Choice Health Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,999.80
|
| Rate for Payer: HealthUtah PPO |
$3,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,939.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,899.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,969.40
|
| Rate for Payer: PacificSource Commercial |
$2,727.00
|
| Rate for Payer: PHCS PPO |
$2,969.40
|
| Rate for Payer: Three Rivers PPO |
$2,272.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,999.80
|
| Rate for Payer: United Healthcare Commercial |
$2,636.10
|
| Rate for Payer: United Healthcare Medicare |
$1,999.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,878.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,878.50
|
|
|
HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
OP
|
$3,030.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4021928501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,669.53 |
| Max. Negotiated Rate |
$3,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,969.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,999.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,908.80
|
| Rate for Payer: Altius Commercial |
$2,908.80
|
| Rate for Payer: Beech Street Commercial |
$2,969.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,487.63
|
| Rate for Payer: Cash Price |
$2,121.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,939.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,969.40
|
| Rate for Payer: Entrust Commercial |
$2,878.50
|
| Rate for Payer: First Choice Health Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,757.40
|
| Rate for Payer: HealthUtah PPO |
$3,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,939.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,669.53
|
| Rate for Payer: One Health Plan of WY PPO |
$2,969.40
|
| Rate for Payer: PacificSource Commercial |
$2,727.00
|
| Rate for Payer: PHCS PPO |
$2,969.40
|
| Rate for Payer: Three Rivers PPO |
$2,272.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,757.40
|
| Rate for Payer: United Healthcare Commercial |
$2,636.10
|
| Rate for Payer: United Healthcare Medicare |
$1,757.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,969.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,878.50
|
|
|
HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Facility
|
IP
|
$3,030.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
4021928501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,899.81 |
| Max. Negotiated Rate |
$3,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,969.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,908.80
|
| Rate for Payer: Altius Commercial |
$2,908.80
|
| Rate for Payer: Beech Street Commercial |
$2,969.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,487.63
|
| Rate for Payer: Cash Price |
$2,121.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,939.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,969.40
|
| Rate for Payer: Entrust Commercial |
$2,878.50
|
| Rate for Payer: First Choice Health Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,878.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,999.80
|
| Rate for Payer: HealthUtah PPO |
$3,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,939.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,899.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,969.40
|
| Rate for Payer: PacificSource Commercial |
$2,727.00
|
| Rate for Payer: PHCS PPO |
$2,969.40
|
| Rate for Payer: Three Rivers PPO |
$2,272.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,999.80
|
| Rate for Payer: United Healthcare Commercial |
$2,636.10
|
| Rate for Payer: United Healthcare Medicare |
$1,999.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,878.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,878.50
|
|
|
HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE
|
Facility
|
OP
|
$3,330.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
3201928102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,834.83 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,197.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,196.80
|
| Rate for Payer: Altius Commercial |
$3,196.80
|
| Rate for Payer: Beech Street Commercial |
$3,263.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,733.93
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: Entrust Commercial |
$3,163.50
|
| Rate for Payer: First Choice Health Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,931.40
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,834.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$3,263.40
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,931.40
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Medicare |
$1,931.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,263.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,163.50
|
|
|
HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE
|
Facility
|
IP
|
$3,330.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
3201928102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,087.91 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,196.80
|
| Rate for Payer: Altius Commercial |
$3,196.80
|
| Rate for Payer: Beech Street Commercial |
$3,263.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,733.93
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: Entrust Commercial |
$3,163.50
|
| Rate for Payer: First Choice Health Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,197.80
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,087.91
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$3,263.40
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,197.80
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Medicare |
$2,197.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,163.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,163.50
|
|
