|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.56
|
| Rate for Payer: Altius Commercial |
$10.56
|
| Rate for Payer: Beech Street Commercial |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.67
|
| Rate for Payer: Cigna of WY Commercial |
$10.78
|
| Rate for Payer: Entrust Commercial |
$10.45
|
| Rate for Payer: First Choice Health Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.26
|
| Rate for Payer: HealthUtah PPO |
$11.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.67
|
| Rate for Payer: Multiplan Medicare/VA |
$6.90
|
| Rate for Payer: One Health Plan of WY PPO |
$10.78
|
| Rate for Payer: PacificSource Commercial |
$9.90
|
| Rate for Payer: PHCS PPO |
$10.78
|
| Rate for Payer: Three Rivers PPO |
$8.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.26
|
| Rate for Payer: United Healthcare Commercial |
$9.57
|
| Rate for Payer: United Healthcare Medicare |
$7.26
|
| Rate for Payer: WINHealth Partners Commercial |
$10.45
|
| Rate for Payer: Wise Provider Network Commercial |
$10.45
|
|
|
HC COMPRESSION STOCKINGS FULL LENGTH/CHAPS STYLE 40-50 MMHG EACH
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS A6538
|
| Hospital Charge Code |
420A653801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$438.90
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$462.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC COMPRESSION STOCKINGS FULL LENGTH/CHAPS STYLE 40-50 MMHG EACH
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS A6538
|
| Hospital Charge Code |
420A653801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$385.70 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$462.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$385.70
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$406.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$406.00
|
| Rate for Payer: WINHealth Partners Commercial |
$686.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
5105752201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Aetna of WY Medicare |
$297.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$247.95
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$261.00
|
| Rate for Payer: WINHealth Partners Commercial |
$441.00
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
5105752201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.15 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$282.15
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$297.00
|
| Rate for Payer: WINHealth Partners Commercial |
$427.50
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
5105752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.32
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$252.05
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$265.32
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$265.32
|
| Rate for Payer: WINHealth Partners Commercial |
$381.90
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
5105752001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Aetna of WY Medicare |
$265.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.16
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$221.50
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$233.16
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$233.16
|
| Rate for Payer: WINHealth Partners Commercial |
$393.96
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC CONTROL THROAT BLEED,SIMPLE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
7614296001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CONTROL THROAT BLEED,SIMPLE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
7614296001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI W/ DBL CONT W/ SMALL BOWEL
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
3207424901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.46 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.40
|
| Rate for Payer: Altius Commercial |
$1,118.40
|
| Rate for Payer: Beech Street Commercial |
$1,141.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.46
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.70
|
| Rate for Payer: Entrust Commercial |
$1,106.75
|
| Rate for Payer: First Choice Health Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.90
|
| Rate for Payer: HealthUtah PPO |
$1,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.05
|
| Rate for Payer: Multiplan Medicare/VA |
$730.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.70
|
| Rate for Payer: PacificSource Commercial |
$1,048.50
|
| Rate for Payer: PHCS PPO |
$1,141.70
|
| Rate for Payer: Three Rivers PPO |
$873.75
|
| Rate for Payer: TriWest Veterans Administration |
$768.90
|
| Rate for Payer: United Healthcare Commercial |
$1,013.55
|
| Rate for Payer: United Healthcare Medicare |
$768.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.75
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI W/ DBL CONT W/ SMALL BOWEL
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 74249
|
| Hospital Charge Code |
3207424901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$641.92 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.70
|
| Rate for Payer: Aetna of WY Medicare |
$768.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.40
|
| Rate for Payer: Altius Commercial |
$1,118.40
|
| Rate for Payer: Beech Street Commercial |
$1,141.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.46
|
| Rate for Payer: Cash Price |
$815.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.70
|
| Rate for Payer: Entrust Commercial |
$1,106.75
|
| Rate for Payer: First Choice Health Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.70
|
| Rate for Payer: HealthUtah PPO |
$1,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.05
|
| Rate for Payer: Multiplan Medicare/VA |
$641.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.70
|
| Rate for Payer: PacificSource Commercial |
$1,048.50
|
| Rate for Payer: PHCS PPO |
$1,141.70
|
| Rate for Payer: Three Rivers PPO |
$873.75
|
| Rate for Payer: TriWest Veterans Administration |
$675.70
|
| Rate for Payer: United Healthcare Commercial |
$1,013.55
|
| Rate for Payer: United Healthcare Medicare |
$675.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.75
|
|
|
HC CORTISOL, FREE - CORTISOL 24HR URINARY FREE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253001
|
|
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 CORTISOL, FREE - CORTISOL 24HR URINARY FREE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253001
|
|
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 CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CPAP/BIPAP INITIATION & MGMT
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,367.49 |
| Max. Negotiated Rate |
$2,181.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,137.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,093.76
|
| Rate for Payer: Altius Commercial |
$2,093.76
|
| Rate for Payer: Beech Street Commercial |
$2,137.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,790.60
|
| Rate for Payer: Cash Price |
$1,526.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,115.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,137.38
|
| Rate for Payer: Entrust Commercial |
$2,071.95
|
| Rate for Payer: First Choice Health Commercial |
$2,071.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,071.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,439.46
|
| Rate for Payer: HealthUtah PPO |
$2,181.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,115.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,367.49
|
| Rate for Payer: One Health Plan of WY PPO |
$2,137.38
|
| Rate for Payer: PacificSource Commercial |
$1,962.90
|
| Rate for Payer: PHCS PPO |
$2,137.38
|
| Rate for Payer: Three Rivers PPO |
$1,635.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,439.46
|
| Rate for Payer: United Healthcare Commercial |
$1,897.47
|
| Rate for Payer: United Healthcare Medicare |
$1,439.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,071.95
|
| Rate for Payer: Wise Provider Network Commercial |
$2,071.95
|
|
|
HC CPAP/BIPAP INITIATION & MGMT
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,201.73 |
| Max. Negotiated Rate |
$2,181.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,137.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,439.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,093.76
|
| Rate for Payer: Altius Commercial |
$2,093.76
|
| Rate for Payer: Beech Street Commercial |
$2,137.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,790.60
|
| Rate for Payer: Cash Price |
$1,526.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,115.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,137.38
|
| Rate for Payer: Entrust Commercial |
$2,071.95
|
| Rate for Payer: First Choice Health Commercial |
$2,071.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,071.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,264.98
|
| Rate for Payer: HealthUtah PPO |
$2,181.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,115.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,201.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2,137.38
|
| Rate for Payer: PacificSource Commercial |
$1,962.90
|
| Rate for Payer: PHCS PPO |
$2,137.38
|
| Rate for Payer: Three Rivers PPO |
$1,635.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,264.98
|
| Rate for Payer: United Healthcare Commercial |
$1,897.47
|
| Rate for Payer: United Healthcare Medicare |
$1,264.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,137.38
|
| Rate for Payer: Wise Provider Network Commercial |
$2,071.95
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| 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 C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| 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 C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| 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 C-REACTIVE PROTEIN,HIGH SENSITIVITY - HIGH SENSITIVITY CRP
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| 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 CREATINE, MB FRACTION - CKMB
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| 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 CREATINE, MB FRACTION - CKMB
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| 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 CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
