|
HC BLADDER IRRIGATION
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
7615170001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
7615170001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
5105170001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.50
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.25
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$13.54
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare |
$14.25
|
| Rate for Payer: WINHealth Partners Commercial |
$24.50
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC BLADDER IRRIGATION
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
5105170001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.25
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$14.49
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$15.25
|
| Rate for Payer: United Healthcare Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare |
$15.25
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$115.90 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$128.00
|
| 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 |
$194.00
|
| 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 |
$122.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$115.90
|
| 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 |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$191.00
|
| Rate for Payer: United Healthcare Medicare |
$122.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.30 |
| 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 Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$194.00
|
| 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 |
$114.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$108.30
|
| 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 |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$191.00
|
| Rate for Payer: United Healthcare Medicare |
$114.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC BLEEDING TIME TEST - BLEEDING TIME
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
3058500201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.74 |
| 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 Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.74
|
| 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 |
$23.94
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$22.74
|
| 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 |
$23.94
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$23.94
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC BLEEDING TIME TEST - BLEEDING TIME
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
3058500201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$26.88
|
| 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 |
$40.74
|
| 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 |
$25.62
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| 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 |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$25.62
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3058522001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$94.08
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.59
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.67
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$85.19
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.67
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$89.67
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
3058522001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.59
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.79
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$79.60
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$83.79
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$83.79
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC BLOOD COUNT RETICULOCYTE AUTOMATED
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
3058504401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.60
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.32
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC BLOOD COUNT RETICULOCYTE AUTOMATED
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
3058504401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.20
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$46.36
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.80
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$48.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC BLOOD CULTURE FOR BACTERIA
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
3068704001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$235.52
|
| Rate for Payer: Altius Commercial |
$353.28
|
| Rate for Payer: Beech Street Commercial |
$360.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: Entrust Commercial |
$349.60
|
| Rate for Payer: First Choice Health Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.48
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$213.26
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$360.64
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.48
|
| Rate for Payer: United Healthcare Commercial |
$351.44
|
| Rate for Payer: United Healthcare Medicare |
$224.48
|
| Rate for Payer: WINHealth Partners Commercial |
$349.60
|
| Rate for Payer: Wise Provider Network Commercial |
$349.60
|
|
|
HC BLOOD CULTURE FOR BACTERIA
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
3068704001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Aetna of WY Medicare |
$242.88
|
| Rate for Payer: Altius Commercial |
$353.28
|
| Rate for Payer: Beech Street Commercial |
$360.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: Entrust Commercial |
$349.60
|
| Rate for Payer: First Choice Health Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.76
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: Multiplan Medicare/VA |
$199.27
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$360.64
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: TriWest Veterans Administration |
$209.76
|
| Rate for Payer: United Healthcare Commercial |
$351.44
|
| Rate for Payer: United Healthcare Medicare |
$209.76
|
| Rate for Payer: WINHealth Partners Commercial |
$360.64
|
| Rate for Payer: Wise Provider Network Commercial |
$349.60
|
|
|
HC BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.43 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$94.38
|
| Rate for Payer: Altius Commercial |
$137.28
|
| Rate for Payer: Beech Street Commercial |
$140.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.71
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: Entrust Commercial |
$135.85
|
| Rate for Payer: First Choice Health Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.51
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$77.43
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$140.14
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$81.51
|
| Rate for Payer: United Healthcare Commercial |
$136.56
|
| Rate for Payer: United Healthcare Medicare |
$81.51
|
| Rate for Payer: WINHealth Partners Commercial |
$140.14
|
| Rate for Payer: Wise Provider Network Commercial |
$135.85
|
|
|
HC BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$91.52
|
| Rate for Payer: Altius Commercial |
$137.28
|
| Rate for Payer: Beech Street Commercial |
$140.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.71
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: Entrust Commercial |
$135.85
|
| Rate for Payer: First Choice Health Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.23
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$82.87
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$140.14
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$87.23
|
| Rate for Payer: United Healthcare Commercial |
$136.56
|
| Rate for Payer: United Healthcare Medicare |
$87.23
|
| Rate for Payer: WINHealth Partners Commercial |
$135.85
|
| Rate for Payer: Wise Provider Network Commercial |
$135.85
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.76 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$317.52
|
| Rate for Payer: Aetna of WY Medicare |
$207.36
|
| Rate for Payer: Altius Commercial |
$311.04
|
| Rate for Payer: Beech Street Commercial |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$314.28
|
| Rate for Payer: Cigna of WY Commercial |
$317.52
|
| Rate for Payer: Entrust Commercial |
$307.80
|
| Rate for Payer: First Choice Health Commercial |
$307.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$307.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.64
|
| Rate for Payer: HealthUtah PPO |
$324.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$314.28
|
| Rate for Payer: Multiplan Medicare/VA |
$187.76
|
| Rate for Payer: One Health Plan of WY PPO |
$317.52
|
| Rate for Payer: PacificSource Commercial |
$291.60
|
| Rate for Payer: PHCS PPO |
$317.52
|
| Rate for Payer: Three Rivers PPO |
$243.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.64
|
| Rate for Payer: United Healthcare Commercial |
$309.42
|
| Rate for Payer: United Healthcare Medicare |
$197.64
|
| Rate for Payer: WINHealth Partners Commercial |
$307.80
|
| Rate for Payer: Wise Provider Network Commercial |
$307.80
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.45 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$317.52
|
| Rate for Payer: Aetna of WY Medicare |
$213.84
|
| Rate for Payer: Altius Commercial |
$311.04
|
| Rate for Payer: Beech Street Commercial |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$314.28
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$314.28
|
| Rate for Payer: Cigna of WY Commercial |
$317.52
|
| Rate for Payer: Entrust Commercial |
$307.80
|
| Rate for Payer: First Choice Health Commercial |
$307.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$307.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.68
|
| Rate for Payer: HealthUtah PPO |
$324.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$314.28
|
| Rate for Payer: Multiplan Medicare/VA |
$175.45
|
| Rate for Payer: One Health Plan of WY PPO |
$317.52
|
| Rate for Payer: PacificSource Commercial |
$291.60
|
| Rate for Payer: PHCS PPO |
$317.52
|
| Rate for Payer: Three Rivers PPO |
$243.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.68
|
| Rate for Payer: United Healthcare Commercial |
$309.42
|
| Rate for Payer: United Healthcare Medicare |
$184.68
|
| Rate for Payer: WINHealth Partners Commercial |
$317.52
|
| Rate for Payer: Wise Provider Network Commercial |
$307.80
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.36 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$176.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.75
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.75
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$159.36
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$167.75
|
| Rate for Payer: United Healthcare Commercial |
$262.62
|
| Rate for Payer: United Healthcare Medicare |
$167.75
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.91 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.75
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.75
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$148.91
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$156.75
|
| Rate for Payer: United Healthcare Commercial |
$262.62
|
| Rate for Payer: United Healthcare Medicare |
$156.75
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
3018305001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$45.44
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.31
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$41.14
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.31
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 83050
|
| Hospital Charge Code |
3018305001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$46.86
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.47
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$38.45
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.47
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$40.47
|
| Rate for Payer: WINHealth Partners Commercial |
$69.58
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC BLOOD OCCULT,BY PEROXID,NONFECAL - COLORECTAL SCREEN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$30.36
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.22
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$24.91
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.22
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$26.22
|
| Rate for Payer: WINHealth Partners Commercial |
$45.08
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC BLOOD OCCULT,BY PEROXID,NONFECAL - COLORECTAL SCREEN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$29.44
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.06
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$26.66
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$28.06
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$28.06
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC BLOOD OCCULT FECAL IMMUNOASSAY
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$73.26
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.27
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$60.11
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$63.27
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WINHealth Partners Commercial |
$108.78
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
