|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 88160
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
3118817201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$534.47 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Aetna of WY Medicare |
$640.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.60
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$534.47
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$562.60
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$562.60
|
| Rate for Payer: WINHealth Partners Commercial |
$950.60
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
3118817201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$608.19 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$950.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$931.20
|
| Rate for Payer: Altius Commercial |
$931.20
|
| Rate for Payer: Beech Street Commercial |
$950.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$796.37
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$940.90
|
| Rate for Payer: Cigna of WY Commercial |
$950.60
|
| Rate for Payer: Entrust Commercial |
$921.50
|
| Rate for Payer: First Choice Health Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$921.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.20
|
| Rate for Payer: HealthUtah PPO |
$970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$940.90
|
| Rate for Payer: Multiplan Medicare/VA |
$608.19
|
| Rate for Payer: One Health Plan of WY PPO |
$950.60
|
| Rate for Payer: PacificSource Commercial |
$873.00
|
| Rate for Payer: PHCS PPO |
$950.60
|
| Rate for Payer: Three Rivers PPO |
$727.50
|
| Rate for Payer: TriWest Veterans Administration |
$640.20
|
| Rate for Payer: United Healthcare Commercial |
$843.90
|
| Rate for Payer: United Healthcare Medicare |
$640.20
|
| Rate for Payer: WINHealth Partners Commercial |
$921.50
|
| Rate for Payer: Wise Provider Network Commercial |
$921.50
|
|
|
HC DAILY ROOM RATE CARE CENTER PRIVATE
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
1000000003
|
|
Hospital Revenue Code
|
100
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$160.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC DAILY ROOM RATE CARE CENTER SEMI PRIVATE
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
1000000001
|
|
Hospital Revenue Code
|
100
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$144.00
|
| 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 DAILY ROOM RATE CARE CENTER SEMI PRIVATE HOSPICE
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
1000000002
|
|
Hospital Revenue Code
|
100
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$140.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC DAILY ROOM RATE HOSPICE CARE IP
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
1100000006
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$460.22 |
| Max. Negotiated Rate |
$734.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$719.32
|
| Rate for Payer: Aetna of WY Medicare |
$469.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$704.64
|
| Rate for Payer: Altius Commercial |
$704.64
|
| Rate for Payer: Beech Street Commercial |
$719.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$602.61
|
| Rate for Payer: Cash Price |
$513.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$711.98
|
| Rate for Payer: Cigna of WY Commercial |
$719.32
|
| Rate for Payer: Entrust Commercial |
$697.30
|
| Rate for Payer: First Choice Health Commercial |
$697.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$697.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$484.44
|
| Rate for Payer: HealthUtah PPO |
$734.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$711.98
|
| Rate for Payer: Multiplan Medicare/VA |
$460.22
|
| Rate for Payer: One Health Plan of WY PPO |
$719.32
|
| Rate for Payer: PacificSource Commercial |
$660.60
|
| Rate for Payer: PHCS PPO |
$719.32
|
| Rate for Payer: Three Rivers PPO |
$550.50
|
| Rate for Payer: TriWest Veterans Administration |
$484.44
|
| Rate for Payer: United Healthcare Commercial |
$638.58
|
| Rate for Payer: United Healthcare Medicare |
$484.44
|
| Rate for Payer: WINHealth Partners Commercial |
$697.30
|
| Rate for Payer: Wise Provider Network Commercial |
$697.30
|
|
|
HC DAILY ROOM RATE RESPITE CARE IP
|
Facility
|
IP
|
$221.00
|
|
| Hospital Charge Code |
1100000007
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$141.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$212.16
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.86
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$138.57
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$145.86
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Medicare |
$145.86
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC DAP CBC
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
3000000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC DAP CBC
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
3000000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC DAP CMP
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000016
|
|
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 DAP CMP
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000016
|
|
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 DAP ESR
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
3000000003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.36
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.14
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$24.36
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$24.36
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC DAP ESR
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
3000000003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.32
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.48
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$26.33
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC DAP FERRITIN
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
3000000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Aetna of WY Medicare |
$34.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
| Rate for Payer: Altius Commercial |
$49.92
|
| Rate for Payer: Beech Street Commercial |
$50.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: Entrust Commercial |
$49.40
|
| Rate for Payer: First Choice Health Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.16
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: Multiplan Medicare/VA |
$28.65
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$50.96
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: TriWest Veterans Administration |
$30.16
|
| Rate for Payer: United Healthcare Commercial |
$45.24
|
| Rate for Payer: United Healthcare Medicare |
$30.16
|
| Rate for Payer: WINHealth Partners Commercial |
$50.96
|
| Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
|
HC DAP FERRITIN
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
3000000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
| Rate for Payer: Altius Commercial |
$49.92
|
| Rate for Payer: Beech Street Commercial |
$50.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: Entrust Commercial |
$49.40
|
| Rate for Payer: First Choice Health Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.32
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$50.96
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.32
|
| Rate for Payer: United Healthcare Commercial |
$45.24
|
| Rate for Payer: United Healthcare Medicare |
$34.32
|
| Rate for Payer: WINHealth Partners Commercial |
$49.40
|
| Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
|
HC DAP FREE T4
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
3000000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| 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 |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| 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 |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC DAP FREE T4
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
3000000010
|
|
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
|
|
|
HC DAP GLYCOHEMOGLOBIN A1C
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000014
|
|
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 DAP GLYCOHEMOGLOBIN A1C
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000014
|
|
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 DAP IRON/IBC
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000017
|
|
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 DAP IRON/IBC
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000017
|
|
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 DAP LIPID PROFILE
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
3000000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.12
|
| Rate for Payer: Aetna of WY Medicare |
$29.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.24
|
| Rate for Payer: Altius Commercial |
$42.24
|
| Rate for Payer: Beech Street Commercial |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.68
|
| Rate for Payer: Cigna of WY Commercial |
$43.12
|
| Rate for Payer: Entrust Commercial |
$41.80
|
| Rate for Payer: First Choice Health Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.52
|
| Rate for Payer: HealthUtah PPO |
$44.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.68
|
| Rate for Payer: Multiplan Medicare/VA |
$24.24
|
| Rate for Payer: One Health Plan of WY PPO |
$43.12
|
| Rate for Payer: PacificSource Commercial |
$39.60
|
| Rate for Payer: PHCS PPO |
$43.12
|
| Rate for Payer: Three Rivers PPO |
$33.00
|
| Rate for Payer: TriWest Veterans Administration |
$25.52
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$25.52
|
| Rate for Payer: WINHealth Partners Commercial |
$43.12
|
| Rate for Payer: Wise Provider Network Commercial |
$41.80
|
|
|
HC DAP LIPID PROFILE
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
3000000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.24
|
| Rate for Payer: Altius Commercial |
$42.24
|
| Rate for Payer: Beech Street Commercial |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.12
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.68
|
| Rate for Payer: Cigna of WY Commercial |
$43.12
|
| Rate for Payer: Entrust Commercial |
$41.80
|
| Rate for Payer: First Choice Health Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.04
|
| Rate for Payer: HealthUtah PPO |
$44.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.68
|
| Rate for Payer: Multiplan Medicare/VA |
$27.59
|
| Rate for Payer: One Health Plan of WY PPO |
$43.12
|
| Rate for Payer: PacificSource Commercial |
$39.60
|
| Rate for Payer: PHCS PPO |
$43.12
|
| Rate for Payer: Three Rivers PPO |
$33.00
|
| Rate for Payer: TriWest Veterans Administration |
$29.04
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$29.04
|
| Rate for Payer: WINHealth Partners Commercial |
$41.80
|
| Rate for Payer: Wise Provider Network Commercial |
$41.80
|
|
