|
HC BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 41105
|
| Hospital Charge Code |
5104110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.18 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.38
|
| Rate for Payer: Aetna of WY Medicare |
$86.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.76
|
| Rate for Payer: Altius Commercial |
$125.76
|
| Rate for Payer: Beech Street Commercial |
$128.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.55
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.07
|
| Rate for Payer: Cigna of WY Commercial |
$128.38
|
| Rate for Payer: Entrust Commercial |
$124.45
|
| Rate for Payer: First Choice Health Commercial |
$124.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.98
|
| Rate for Payer: HealthUtah PPO |
$131.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.07
|
| Rate for Payer: Multiplan Medicare/VA |
$72.18
|
| Rate for Payer: One Health Plan of WY PPO |
$128.38
|
| Rate for Payer: PacificSource Commercial |
$117.90
|
| Rate for Payer: PHCS PPO |
$128.38
|
| Rate for Payer: Three Rivers PPO |
$98.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.98
|
| Rate for Payer: United Healthcare Commercial |
$113.97
|
| Rate for Payer: United Healthcare Medicare |
$75.98
|
| Rate for Payer: WINHealth Partners Commercial |
$128.38
|
| Rate for Payer: Wise Provider Network Commercial |
$124.45
|
|
|
HC BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 41105
|
| Hospital Charge Code |
5104110501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.76
|
| Rate for Payer: Altius Commercial |
$125.76
|
| Rate for Payer: Beech Street Commercial |
$128.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.55
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$127.07
|
| Rate for Payer: Cigna of WY Commercial |
$128.38
|
| Rate for Payer: Entrust Commercial |
$124.45
|
| Rate for Payer: First Choice Health Commercial |
$124.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.46
|
| Rate for Payer: HealthUtah PPO |
$131.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$127.07
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$128.38
|
| Rate for Payer: PacificSource Commercial |
$117.90
|
| Rate for Payer: PHCS PPO |
$128.38
|
| Rate for Payer: Three Rivers PPO |
$98.25
|
| Rate for Payer: TriWest Veterans Administration |
$86.46
|
| Rate for Payer: United Healthcare Commercial |
$113.97
|
| Rate for Payer: United Healthcare Medicare |
$86.46
|
| Rate for Payer: WINHealth Partners Commercial |
$124.45
|
| Rate for Payer: Wise Provider Network Commercial |
$124.45
|
|
|
HC BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 57105
|
| Hospital Charge Code |
5105710501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 57105
|
| Hospital Charge Code |
5105710501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.97 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$213.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$310.08
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$265.18
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.34
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$177.97
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$187.34
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$187.34
|
| Rate for Payer: WINHealth Partners Commercial |
$316.54
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC BIOPSY VAGINAL MUCOSA SIMPLE
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.52 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$310.08
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$265.18
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.18
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$202.52
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$213.18
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$213.18
|
| Rate for Payer: WINHealth Partners Commercial |
$306.85
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC BIOPSY VESTIBULE MOUTH
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
5104080801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.44
|
| Rate for Payer: Altius Commercial |
$85.44
|
| Rate for Payer: Beech Street Commercial |
$87.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: Entrust Commercial |
$84.55
|
| Rate for Payer: First Choice Health Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$55.80
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$87.22
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$84.55
|
| Rate for Payer: Wise Provider Network Commercial |
$84.55
|
|
|
HC BIOPSY VESTIBULE MOUTH
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
5104080801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.44
|
| Rate for Payer: Altius Commercial |
$85.44
|
| Rate for Payer: Beech Street Commercial |
$87.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: Entrust Commercial |
$84.55
|
| Rate for Payer: First Choice Health Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.62
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$49.04
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$87.22
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$51.62
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$51.62
|
| Rate for Payer: WINHealth Partners Commercial |
$87.22
|
| Rate for Payer: Wise Provider Network Commercial |
$84.55
|
|
|
HC BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.48
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.72
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.58
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$39.50
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.58
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$41.58
|
| Rate for Payer: WINHealth Partners Commercial |
$59.85
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
HC BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.48
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.72
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.54
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$34.71
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.54
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$36.54
|
| Rate for Payer: WINHealth Partners Commercial |
$61.74
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
HC BIOPSY VULVA/PERINEUM,ONE LESN
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
5105660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.16
|
| Rate for Payer: Aetna of WY Medicare |
$93.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$136.32
|
| Rate for Payer: Altius Commercial |
$136.32
|
| Rate for Payer: Beech Street Commercial |
$139.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.74
|
| Rate for Payer: Cigna of WY Commercial |
$139.16
|
| Rate for Payer: Entrust Commercial |
$134.90
|
| Rate for Payer: First Choice Health Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.36
|
| Rate for Payer: HealthUtah PPO |
$142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.74
|
| Rate for Payer: Multiplan Medicare/VA |
$78.24
|
| Rate for Payer: One Health Plan of WY PPO |
$139.16
|
| Rate for Payer: PacificSource Commercial |
$127.80
|
| Rate for Payer: PHCS PPO |
$139.16
|
| Rate for Payer: Three Rivers PPO |
$106.50
|
| Rate for Payer: TriWest Veterans Administration |
$82.36
|
| Rate for Payer: United Healthcare Commercial |
$123.54
|
| Rate for Payer: United Healthcare Medicare |
$82.36
|
| Rate for Payer: WINHealth Partners Commercial |
$139.16
|
| Rate for Payer: Wise Provider Network Commercial |
$134.90
|
|
|
HC BIOPSY VULVA/PERINEUM,ONE LESN
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
5105660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$136.32
|
| Rate for Payer: Altius Commercial |
$136.32
|
| Rate for Payer: Beech Street Commercial |
$139.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.58
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.74
|
| Rate for Payer: Cigna of WY Commercial |
$139.16
|
| Rate for Payer: Entrust Commercial |
$134.90
|
| Rate for Payer: First Choice Health Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.72
|
| Rate for Payer: HealthUtah PPO |
$142.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.74
|
| Rate for Payer: Multiplan Medicare/VA |
$89.03
|
| Rate for Payer: One Health Plan of WY PPO |
$139.16
|
| Rate for Payer: PacificSource Commercial |
$127.80
|
| Rate for Payer: PHCS PPO |
$139.16
|
| Rate for Payer: Three Rivers PPO |
$106.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.72
|
| Rate for Payer: United Healthcare Commercial |
$123.54
|
| Rate for Payer: United Healthcare Medicare |
$93.72
|
| Rate for Payer: WINHealth Partners Commercial |
$134.90
|
| Rate for Payer: Wise Provider Network Commercial |
$134.90
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
5105170001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.72
|
| Rate for Payer: Altius Commercial |
$30.72
|
| Rate for Payer: Beech Street Commercial |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: Entrust Commercial |
$30.40
|
| Rate for Payer: First Choice Health Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.12
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: Multiplan Medicare/VA |
$20.06
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$31.36
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$21.12
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$21.12
|
| Rate for Payer: WINHealth Partners Commercial |
$30.40
|
| Rate for Payer: Wise Provider Network Commercial |
$30.40
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
7615170001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
7615170001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
5105170001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Aetna of WY Medicare |
$21.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.72
|
| Rate for Payer: Altius Commercial |
$30.72
|
| Rate for Payer: Beech Street Commercial |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: Entrust Commercial |
$30.40
|
| Rate for Payer: First Choice Health Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.56
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: Multiplan Medicare/VA |
$17.63
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$31.36
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$18.56
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
| Rate for Payer: WINHealth Partners Commercial |
$31.36
|
| Rate for Payer: Wise Provider Network Commercial |
$30.40
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.30
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$128.54
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$135.30
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$135.30
|
| Rate for Payer: WINHealth Partners Commercial |
$194.75
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Aetna of WY Medicare |
$135.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.90
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$112.96
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.90
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$118.90
|
| Rate for Payer: WINHealth Partners Commercial |
$200.90
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC BLEEDING TIME TEST - BLEEDING TIME
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
3058500201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.70
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$28.22
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$29.70
|
| Rate for Payer: WINHealth Partners Commercial |
$42.75
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC BLEEDING TIME TEST - BLEEDING TIME
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
3058500201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$29.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.10
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$24.80
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
| Rate for Payer: WINHealth Partners Commercial |
$44.10
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3058522001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3058522001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC BLOOD COUNT RETICULOCYTE AUTOMATED
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
3058504401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC BLOOD COUNT RETICULOCYTE AUTOMATED
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
3058504401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT - VET
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
