|
HC TOTAL CORTISOL - CORTISOL SALIVA
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC TOTAL CORTISOL - CORTISOL SALIVA
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC TOTAL CORTISOL - CORTISOL SERUM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC TOTAL CORTISOL - CORTISOL SERUM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC TOTAL KNEE ORTHO PROCEDURE
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
3600000032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.46 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,370.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,943.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,281.60
|
| Rate for Payer: Altius Commercial |
$4,281.60
|
| Rate for Payer: Beech Street Commercial |
$4,370.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,661.66
|
| Rate for Payer: Cash Price |
$3,122.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,326.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,370.80
|
| Rate for Payer: Entrust Commercial |
$4,237.00
|
| Rate for Payer: First Choice Health Commercial |
$4,237.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,237.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,586.80
|
| Rate for Payer: HealthUtah PPO |
$4,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,326.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,457.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,370.80
|
| Rate for Payer: PacificSource Commercial |
$4,014.00
|
| Rate for Payer: PHCS PPO |
$4,370.80
|
| Rate for Payer: Three Rivers PPO |
$3,345.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,586.80
|
| Rate for Payer: United Healthcare Commercial |
$3,880.20
|
| Rate for Payer: United Healthcare Medicare |
$2,586.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,370.80
|
| Rate for Payer: Wise Provider Network Commercial |
$4,237.00
|
|
|
HC TOTAL KNEE ORTHO PROCEDURE
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
3600000032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,796.42 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,370.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,281.60
|
| Rate for Payer: Altius Commercial |
$4,281.60
|
| Rate for Payer: Beech Street Commercial |
$4,370.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,661.66
|
| Rate for Payer: Cash Price |
$3,122.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,326.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,370.80
|
| Rate for Payer: Entrust Commercial |
$4,237.00
|
| Rate for Payer: First Choice Health Commercial |
$4,237.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,237.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,943.60
|
| Rate for Payer: HealthUtah PPO |
$4,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,326.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,796.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4,370.80
|
| Rate for Payer: PacificSource Commercial |
$4,014.00
|
| Rate for Payer: PHCS PPO |
$4,370.80
|
| Rate for Payer: Three Rivers PPO |
$3,345.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,943.60
|
| Rate for Payer: United Healthcare Commercial |
$3,880.20
|
| Rate for Payer: United Healthcare Medicare |
$2,943.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,237.00
|
|
|
HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
3028677801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
3028677801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777 91
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777 90
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777 91
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86777 90
|
| Hospital Charge Code |
3028677701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 57720
|
| Hospital Charge Code |
5105772001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.22 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Aetna of WY Medicare |
$209.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.44
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$175.22
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$184.44
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$184.44
|
| Rate for Payer: WINHealth Partners Commercial |
$311.64
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 57720
|
| Hospital Charge Code |
5105772001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.88
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$199.39
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$209.88
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$209.88
|
| Rate for Payer: WINHealth Partners Commercial |
$302.10
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3018446001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3018446001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
3018445001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
3018445001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
5109949501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.49 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.12
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.16
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.52
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$76.49
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.52
|
| Rate for Payer: United Healthcare Commercial |
$106.14
|
| Rate for Payer: United Healthcare Medicare |
$80.52
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 99495
|
| Hospital Charge Code |
5109949501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.12
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.16
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$106.14
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC TRANSPORT PORTABLE X-RAY > ONE PT
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS R0075
|
| Hospital Charge Code |
329R007501
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$200.64
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.20
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$211.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC TRANSPORT PORTABLE X-RAY > ONE PT
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS R0075
|
| Hospital Charge Code |
329R007501
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.60
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$176.32
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.60
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$185.60
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC TRANSPORT PORTABLE X-RAY ONE PT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS R0070
|
| Hospital Charge Code |
329R007001
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
