|
HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR 8 ACTIVITY
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3058524001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.60
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$176.32
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.60
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$185.60
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$200.64
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.20
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$211.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
3058526001
|
|
Hospital Revenue Code
|
305
|
| 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 CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
3058526001
|
|
Hospital Revenue Code
|
305
|
| 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 CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| 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 CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| 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 CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S,TOTAL & FREE
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3058530501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$167.41 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$261.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$256.32
|
| Rate for Payer: Altius Commercial |
$256.32
|
| Rate for Payer: Beech Street Commercial |
$261.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$219.21
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.99
|
| Rate for Payer: Cigna of WY Commercial |
$261.66
|
| Rate for Payer: Entrust Commercial |
$253.65
|
| Rate for Payer: First Choice Health Commercial |
$253.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.22
|
| Rate for Payer: HealthUtah PPO |
$267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.99
|
| Rate for Payer: Multiplan Medicare/VA |
$167.41
|
| Rate for Payer: One Health Plan of WY PPO |
$261.66
|
| Rate for Payer: PacificSource Commercial |
$240.30
|
| Rate for Payer: PHCS PPO |
$261.66
|
| Rate for Payer: Three Rivers PPO |
$200.25
|
| Rate for Payer: TriWest Veterans Administration |
$176.22
|
| Rate for Payer: United Healthcare Commercial |
$232.29
|
| Rate for Payer: United Healthcare Medicare |
$176.22
|
| Rate for Payer: WINHealth Partners Commercial |
$253.65
|
| Rate for Payer: Wise Provider Network Commercial |
$253.65
|
|
|
HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S,TOTAL & FREE
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
3058530501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$261.66
|
| Rate for Payer: Aetna of WY Medicare |
$176.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$256.32
|
| Rate for Payer: Altius Commercial |
$256.32
|
| Rate for Payer: Beech Street Commercial |
$261.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$219.21
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.99
|
| Rate for Payer: Cigna of WY Commercial |
$261.66
|
| Rate for Payer: Entrust Commercial |
$253.65
|
| Rate for Payer: First Choice Health Commercial |
$253.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.86
|
| Rate for Payer: HealthUtah PPO |
$267.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.99
|
| Rate for Payer: Multiplan Medicare/VA |
$147.12
|
| Rate for Payer: One Health Plan of WY PPO |
$261.66
|
| Rate for Payer: PacificSource Commercial |
$240.30
|
| Rate for Payer: PHCS PPO |
$261.66
|
| Rate for Payer: Three Rivers PPO |
$200.25
|
| Rate for Payer: TriWest Veterans Administration |
$154.86
|
| Rate for Payer: United Healthcare Commercial |
$232.29
|
| Rate for Payer: United Healthcare Medicare |
$154.86
|
| Rate for Payer: WINHealth Partners Commercial |
$261.66
|
| Rate for Payer: Wise Provider Network Commercial |
$253.65
|
|
|
HC CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 23540
|
| Hospital Charge Code |
5102354001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 23540
|
| Hospital Charge Code |
5102354001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
5102365501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.05 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$394.94
|
| Rate for Payer: Aetna of WY Medicare |
$265.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$386.88
|
| Rate for Payer: Altius Commercial |
$386.88
|
| Rate for Payer: Beech Street Commercial |
$394.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.86
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$390.91
|
| Rate for Payer: Cigna of WY Commercial |
$394.94
|
| Rate for Payer: Entrust Commercial |
$382.85
|
| Rate for Payer: First Choice Health Commercial |
$382.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$382.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.74
|
| Rate for Payer: HealthUtah PPO |
$403.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$390.91
|
| Rate for Payer: Multiplan Medicare/VA |
$222.05
|
| Rate for Payer: One Health Plan of WY PPO |
$394.94
|
| Rate for Payer: PacificSource Commercial |
$362.70
|
| Rate for Payer: PHCS PPO |
$394.94
|
| Rate for Payer: Three Rivers PPO |
$302.25
|
| Rate for Payer: TriWest Veterans Administration |
$233.74
|
| Rate for Payer: United Healthcare Commercial |
$350.61
|
| Rate for Payer: United Healthcare Medicare |
$233.74
|
| Rate for Payer: WINHealth Partners Commercial |
$394.94
|
| Rate for Payer: Wise Provider Network Commercial |
$382.85
|
|
|
HC CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
5102365501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$252.68 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$394.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$386.88
|
| Rate for Payer: Altius Commercial |
$386.88
|
| Rate for Payer: Beech Street Commercial |
$394.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.86
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$390.91
|
| Rate for Payer: Cigna of WY Commercial |
$394.94
|
| Rate for Payer: Entrust Commercial |
$382.85
|
| Rate for Payer: First Choice Health Commercial |
$382.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$382.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.98
|
| Rate for Payer: HealthUtah PPO |
$403.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$390.91
|
| Rate for Payer: Multiplan Medicare/VA |
$252.68
|
| Rate for Payer: One Health Plan of WY PPO |
$394.94
|
| Rate for Payer: PacificSource Commercial |
$362.70
|
| Rate for Payer: PHCS PPO |
$394.94
|
| Rate for Payer: Three Rivers PPO |
$302.25
|
| Rate for Payer: TriWest Veterans Administration |
$265.98
|
| Rate for Payer: United Healthcare Commercial |
$350.61
|
| Rate for Payer: United Healthcare Medicare |
$265.98
|
| Rate for Payer: WINHealth Partners Commercial |
$382.85
|
| Rate for Payer: Wise Provider Network Commercial |
$382.85
|
|
|
HC CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
5102365001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$283.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$277.44
|
| Rate for Payer: Altius Commercial |
$277.44
|
| Rate for Payer: Beech Street Commercial |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$237.27
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$280.33
|
| Rate for Payer: Cigna of WY Commercial |
$283.22
|
| Rate for Payer: Entrust Commercial |
$274.55
|
| Rate for Payer: First Choice Health Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.74
|
| Rate for Payer: HealthUtah PPO |
$289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$280.33
|
| Rate for Payer: Multiplan Medicare/VA |
$181.20
|
| Rate for Payer: One Health Plan of WY PPO |
$283.22
|
| Rate for Payer: PacificSource Commercial |
$260.10
|
| Rate for Payer: PHCS PPO |
$283.22
|
| Rate for Payer: Three Rivers PPO |
$216.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.74
|
| Rate for Payer: United Healthcare Commercial |
$251.43
|
| Rate for Payer: United Healthcare Medicare |
$190.74
|
| Rate for Payer: WINHealth Partners Commercial |
$274.55
|
| Rate for Payer: Wise Provider Network Commercial |
$274.55
|
|
|
HC CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
5102365001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$283.22
|
| Rate for Payer: Aetna of WY Medicare |
$190.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$277.44
|
| Rate for Payer: Altius Commercial |
$277.44
|
| Rate for Payer: Beech Street Commercial |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$237.27
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$280.33
|
| Rate for Payer: Cigna of WY Commercial |
$283.22
|
| Rate for Payer: Entrust Commercial |
$274.55
|
| Rate for Payer: First Choice Health Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.62
|
| Rate for Payer: HealthUtah PPO |
$289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$280.33
|
| Rate for Payer: Multiplan Medicare/VA |
$159.24
|
| Rate for Payer: One Health Plan of WY PPO |
$283.22
|
| Rate for Payer: PacificSource Commercial |
$260.10
|
| Rate for Payer: PHCS PPO |
$283.22
|
| Rate for Payer: Three Rivers PPO |
$216.75
|
| Rate for Payer: TriWest Veterans Administration |
$167.62
|
| Rate for Payer: United Healthcare Commercial |
$251.43
|
| Rate for Payer: United Healthcare Medicare |
$167.62
|
| Rate for Payer: WINHealth Partners Commercial |
$283.22
|
| Rate for Payer: Wise Provider Network Commercial |
$274.55
|
|
|
HC CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
5105730501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.67 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.68
|
| Rate for Payer: Aetna of WY Medicare |
$241.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$351.36
|
| Rate for Payer: Altius Commercial |
$351.36
|
| Rate for Payer: Beech Street Commercial |
$358.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$300.49
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.02
|
| Rate for Payer: Cigna of WY Commercial |
$358.68
|
| Rate for Payer: Entrust Commercial |
$347.70
|
| Rate for Payer: First Choice Health Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$212.28
|
| Rate for Payer: HealthUtah PPO |
$366.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.02
|
| Rate for Payer: Multiplan Medicare/VA |
$201.67
|
| Rate for Payer: One Health Plan of WY PPO |
$358.68
|
| Rate for Payer: PacificSource Commercial |
$329.40
|
| Rate for Payer: PHCS PPO |
$358.68
|
| Rate for Payer: Three Rivers PPO |
$274.50
|
| Rate for Payer: TriWest Veterans Administration |
$212.28
|
| Rate for Payer: United Healthcare Commercial |
$318.42
|
| Rate for Payer: United Healthcare Medicare |
$212.28
|
| Rate for Payer: WINHealth Partners Commercial |
$358.68
|
| Rate for Payer: Wise Provider Network Commercial |
$347.70
|
|
|
HC CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
5105730501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.48 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$351.36
|
| Rate for Payer: Altius Commercial |
$351.36
|
| Rate for Payer: Beech Street Commercial |
$358.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$300.49
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.02
|
| Rate for Payer: Cigna of WY Commercial |
$358.68
|
| Rate for Payer: Entrust Commercial |
$347.70
|
| Rate for Payer: First Choice Health Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$241.56
|
| Rate for Payer: HealthUtah PPO |
$366.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.02
|
| Rate for Payer: Multiplan Medicare/VA |
$229.48
|
| Rate for Payer: One Health Plan of WY PPO |
$358.68
|
| Rate for Payer: PacificSource Commercial |
$329.40
|
| Rate for Payer: PHCS PPO |
$358.68
|
| Rate for Payer: Three Rivers PPO |
$274.50
|
| Rate for Payer: TriWest Veterans Administration |
$241.56
|
| Rate for Payer: United Healthcare Commercial |
$318.42
|
| Rate for Payer: United Healthcare Medicare |
$241.56
|
| Rate for Payer: WINHealth Partners Commercial |
$347.70
|
| Rate for Payer: Wise Provider Network Commercial |
$347.70
|
|
