|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$457.33 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Aetna of WY Medicare |
$547.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.40
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.33
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.40
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$481.40
|
| Rate for Payer: WINHealth Partners Commercial |
$813.40
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$520.41 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$547.80
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$520.41
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$547.80
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$547.80
|
| Rate for Payer: WINHealth Partners Commercial |
$788.50
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$617.40
|
| Rate for Payer: Aetna of WY Medicare |
$415.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$604.80
|
| Rate for Payer: Altius Commercial |
$604.80
|
| Rate for Payer: Beech Street Commercial |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.23
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$611.10
|
| Rate for Payer: Cigna of WY Commercial |
$617.40
|
| Rate for Payer: Entrust Commercial |
$598.50
|
| Rate for Payer: First Choice Health Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.40
|
| Rate for Payer: HealthUtah PPO |
$630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$611.10
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$617.40
|
| Rate for Payer: PacificSource Commercial |
$567.00
|
| Rate for Payer: PHCS PPO |
$617.40
|
| Rate for Payer: Three Rivers PPO |
$472.50
|
| Rate for Payer: TriWest Veterans Administration |
$365.40
|
| Rate for Payer: United Healthcare Commercial |
$548.10
|
| Rate for Payer: United Healthcare Medicare |
$365.40
|
| Rate for Payer: WINHealth Partners Commercial |
$617.40
|
| Rate for Payer: Wise Provider Network Commercial |
$598.50
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$395.01 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$617.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$604.80
|
| Rate for Payer: Altius Commercial |
$604.80
|
| Rate for Payer: Beech Street Commercial |
$617.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$517.23
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$611.10
|
| Rate for Payer: Cigna of WY Commercial |
$617.40
|
| Rate for Payer: Entrust Commercial |
$598.50
|
| Rate for Payer: First Choice Health Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$415.80
|
| Rate for Payer: HealthUtah PPO |
$630.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$611.10
|
| Rate for Payer: Multiplan Medicare/VA |
$395.01
|
| Rate for Payer: One Health Plan of WY PPO |
$617.40
|
| Rate for Payer: PacificSource Commercial |
$567.00
|
| Rate for Payer: PHCS PPO |
$617.40
|
| Rate for Payer: Three Rivers PPO |
$472.50
|
| Rate for Payer: TriWest Veterans Administration |
$415.80
|
| Rate for Payer: United Healthcare Commercial |
$548.10
|
| Rate for Payer: United Healthcare Medicare |
$415.80
|
| Rate for Payer: WINHealth Partners Commercial |
$598.50
|
| Rate for Payer: Wise Provider Network Commercial |
$598.50
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3359641101
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3359641101
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
3359640901
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$322.90 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$494.40
|
| Rate for Payer: Altius Commercial |
$494.40
|
| Rate for Payer: Beech Street Commercial |
$504.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$422.82
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: Entrust Commercial |
$489.25
|
| Rate for Payer: First Choice Health Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.90
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$322.90
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$504.70
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$339.90
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$339.90
|
| Rate for Payer: WINHealth Partners Commercial |
$489.25
|
| Rate for Payer: Wise Provider Network Commercial |
$489.25
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
3359640901
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$283.76 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$339.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$494.40
|
| Rate for Payer: Altius Commercial |
$494.40
|
| Rate for Payer: Beech Street Commercial |
$504.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$422.82
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: Entrust Commercial |
$489.25
|
| Rate for Payer: First Choice Health Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.70
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$283.76
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$504.70
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$298.70
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$298.70
|
| Rate for Payer: WINHealth Partners Commercial |
$504.70
|
| Rate for Payer: Wise Provider Network Commercial |
$489.25
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$520.70 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Aetna of WY Medicare |
$623.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$907.20
|
| Rate for Payer: Altius Commercial |
$907.20
|
| Rate for Payer: Beech Street Commercial |
$926.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$775.84
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: Entrust Commercial |
$897.75
|
| Rate for Payer: First Choice Health Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$548.10
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$520.70
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$926.10
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$548.10
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$548.10
|
| Rate for Payer: WINHealth Partners Commercial |
$926.10
|
| Rate for Payer: Wise Provider Network Commercial |
$897.75
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$592.52 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$907.20
|
| Rate for Payer: Altius Commercial |
$907.20
|
| Rate for Payer: Beech Street Commercial |
$926.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$775.84
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: Entrust Commercial |
$897.75
|
| Rate for Payer: First Choice Health Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$623.70
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$592.52
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$926.10
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$623.70
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
| Rate for Payer: WINHealth Partners Commercial |
$897.75
|
| Rate for Payer: Wise Provider Network Commercial |
$897.75
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
2603659201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
2603659201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
3003659201
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
3003659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| 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 |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| 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 |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
7613659101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$195.84
|
| Rate for Payer: Altius Commercial |
$195.84
|
| Rate for Payer: Beech Street Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.48
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: Entrust Commercial |
$193.80
|
| Rate for Payer: First Choice Health Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.64
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$127.91
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PHCS PPO |
$199.92
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$134.64
|
| Rate for Payer: United Healthcare Commercial |
$177.48
|
| Rate for Payer: United Healthcare Medicare |
$134.64
|
| Rate for Payer: WINHealth Partners Commercial |
$193.80
|
| Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
|
HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
5103659101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$14.42
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
5103659101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC CHG COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
7613659101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Aetna of WY Medicare |
$134.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$195.84
|
| Rate for Payer: Altius Commercial |
$195.84
|
| Rate for Payer: Beech Street Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.48
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: Entrust Commercial |
$193.80
|
| Rate for Payer: First Choice Health Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.32
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$112.40
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PHCS PPO |
$199.92
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.32
|
| Rate for Payer: United Healthcare Commercial |
$177.48
|
| Rate for Payer: United Healthcare Medicare |
$118.32
|
| Rate for Payer: WINHealth Partners Commercial |
$199.92
|
| Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
|
HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
9833641501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.73 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$237.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$232.32
|
| Rate for Payer: Altius Commercial |
$232.32
|
| Rate for Payer: Beech Street Commercial |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.68
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$234.74
|
| Rate for Payer: Cigna of WY Commercial |
$237.16
|
| Rate for Payer: Entrust Commercial |
$229.90
|
| Rate for Payer: First Choice Health Commercial |
$229.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.72
|
| Rate for Payer: HealthUtah PPO |
$242.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$234.74
|
| Rate for Payer: Multiplan Medicare/VA |
$151.73
|
| Rate for Payer: One Health Plan of WY PPO |
$237.16
|
| Rate for Payer: PacificSource Commercial |
$217.80
|
| Rate for Payer: PHCS PPO |
$237.16
|
| Rate for Payer: Three Rivers PPO |
$181.50
|
| Rate for Payer: TriWest Veterans Administration |
$159.72
|
| Rate for Payer: United Healthcare Commercial |
$210.54
|
| Rate for Payer: United Healthcare Medicare |
$159.72
|
| Rate for Payer: WINHealth Partners Commercial |
$229.90
|
| Rate for Payer: Wise Provider Network Commercial |
$229.90
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
9833641501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$237.16
|
| Rate for Payer: Aetna of WY Medicare |
$159.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$232.32
|
| Rate for Payer: Altius Commercial |
$232.32
|
| Rate for Payer: Beech Street Commercial |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.68
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$234.74
|
| Rate for Payer: Cigna of WY Commercial |
$237.16
|
| Rate for Payer: Entrust Commercial |
$229.90
|
| Rate for Payer: First Choice Health Commercial |
$229.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$229.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.36
|
| Rate for Payer: HealthUtah PPO |
$242.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$234.74
|
| Rate for Payer: Multiplan Medicare/VA |
$133.34
|
| Rate for Payer: One Health Plan of WY PPO |
$237.16
|
| Rate for Payer: PacificSource Commercial |
$217.80
|
| Rate for Payer: PHCS PPO |
$237.16
|
| Rate for Payer: Three Rivers PPO |
$181.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.36
|
| Rate for Payer: United Healthcare Commercial |
$210.54
|
| Rate for Payer: United Healthcare Medicare |
$140.36
|
| Rate for Payer: WINHealth Partners Commercial |
$237.16
|
| Rate for Payer: Wise Provider Network Commercial |
$229.90
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
