|
HC BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT - VET
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| 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 |
$22.62
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| 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 |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC BLOOD CULTURE FOR BACTERIA
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
3068704001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.80
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$238.26
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$250.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$250.80
|
| Rate for Payer: WINHealth Partners Commercial |
$361.00
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC BLOOD CULTURE FOR BACTERIA
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
3068704001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$250.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.40
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$209.38
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$220.40
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$220.40
|
| Rate for Payer: WINHealth Partners Commercial |
$372.40
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| 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 BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| 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 GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$326.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$485.10
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$310.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.70
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$310.36
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$326.70
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$326.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$485.10
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$310.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.70
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$310.36
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$326.70
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
3018305001
|
|
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 BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
3018305001
|
|
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 BLOOD OCCULT,BY PEROXID,NONFECAL - COLORECTAL SCREEN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC BLOOD OCCULT,BY PEROXID,NONFECAL - COLORECTAL SCREEN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC BLOOD OCCULT FECAL IMMUNOASSAY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| 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 BLOOD OCCULT FECAL IMMUNOASSAY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| 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 BLOOD PH - PH VENOUS
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| 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 BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| 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 BLOOD SMEAR PLATELET MANUAL COUNT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
3008503201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC BLOOD SMEAR PLATELET MANUAL COUNT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
3008503201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.04
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.94
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.04
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$22.04
|
| Rate for Payer: WINHealth Partners Commercial |
$37.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$924.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$812.72 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$812.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$855.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$855.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,445.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
|
HC BLOOD TRANSFUSION SERVICE EACH ADDITIONAL UNIT
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$924.82 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$973.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$924.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$973.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$973.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
|
HC BLOOD TRANSFUSION SERVICE EACH ADDITIONAL UNIT
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$812.72 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,445.50
|
| Rate for Payer: Aetna of WY Medicare |
$973.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,416.00
|
| Rate for Payer: Altius Commercial |
$1,416.00
|
| Rate for Payer: Beech Street Commercial |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,210.98
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,430.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,445.50
|
| Rate for Payer: Entrust Commercial |
$1,401.25
|
| Rate for Payer: First Choice Health Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,401.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.50
|
| Rate for Payer: HealthUtah PPO |
$1,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,430.75
|
| Rate for Payer: Multiplan Medicare/VA |
$812.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,445.50
|
| Rate for Payer: PacificSource Commercial |
$1,327.50
|
| Rate for Payer: PHCS PPO |
$1,445.50
|
| Rate for Payer: Three Rivers PPO |
$1,106.25
|
| Rate for Payer: TriWest Veterans Administration |
$855.50
|
| Rate for Payer: United Healthcare Commercial |
$1,283.25
|
| Rate for Payer: United Healthcare Medicare |
$855.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,445.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,401.25
|
|
