|
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
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.05
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$89.35
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$157.58
|
| Rate for Payer: United Healthcare Medicare |
$94.05
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.65
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$95.62
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.65
|
| Rate for Payer: United Healthcare Commercial |
$157.58
|
| Rate for Payer: United Healthcare Medicare |
$100.65
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$34.98
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.21
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$28.70
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$30.21
|
| Rate for Payer: United Healthcare Commercial |
$50.62
|
| Rate for Payer: United Healthcare Medicare |
$30.21
|
| Rate for Payer: WINHealth Partners Commercial |
$51.94
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$33.92
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.33
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$30.71
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.33
|
| Rate for Payer: United Healthcare Commercial |
$50.62
|
| Rate for Payer: United Healthcare Medicare |
$32.33
|
| Rate for Payer: WINHealth Partners Commercial |
$50.35
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC BLOOD SMEAR PLATELET MANUAL COUNT
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
3008503201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$24.42
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.09
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$20.04
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$35.34
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WINHealth Partners Commercial |
$36.26
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC BLOOD SMEAR PLATELET MANUAL COUNT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
3008503201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.44 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$23.68
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.57
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$21.44
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$22.57
|
| Rate for Payer: United Healthcare Commercial |
$35.34
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$795.65 |
| Max. Negotiated Rate |
$1,373.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,345.54
|
| Rate for Payer: Aetna of WY Medicare |
$878.72
|
| Rate for Payer: Altius Commercial |
$1,318.08
|
| Rate for Payer: Beech Street Commercial |
$1,345.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,331.81
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,331.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,345.54
|
| Rate for Payer: Entrust Commercial |
$1,304.35
|
| Rate for Payer: First Choice Health Commercial |
$1,304.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,304.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$837.53
|
| Rate for Payer: HealthUtah PPO |
$1,373.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,331.81
|
| Rate for Payer: Multiplan Medicare/VA |
$795.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,345.54
|
| Rate for Payer: PacificSource Commercial |
$1,235.70
|
| Rate for Payer: PHCS PPO |
$1,345.54
|
| Rate for Payer: Three Rivers PPO |
$1,029.75
|
| Rate for Payer: TriWest Veterans Administration |
$837.53
|
| Rate for Payer: United Healthcare Commercial |
$1,311.22
|
| Rate for Payer: United Healthcare Medicare |
$837.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,304.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,304.35
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$743.48 |
| Max. Negotiated Rate |
$1,373.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,345.54
|
| Rate for Payer: Aetna of WY Medicare |
$906.18
|
| Rate for Payer: Altius Commercial |
$1,318.08
|
| Rate for Payer: Beech Street Commercial |
$1,345.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,331.81
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,331.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,345.54
|
| Rate for Payer: Entrust Commercial |
$1,304.35
|
| Rate for Payer: First Choice Health Commercial |
$1,304.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,304.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$782.61
|
| Rate for Payer: HealthUtah PPO |
$1,373.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,331.81
|
| Rate for Payer: Multiplan Medicare/VA |
$743.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,345.54
|
| Rate for Payer: PacificSource Commercial |
$1,235.70
|
| Rate for Payer: PHCS PPO |
$1,345.54
|
| Rate for Payer: Three Rivers PPO |
$1,029.75
|
| Rate for Payer: TriWest Veterans Administration |
$782.61
|
| Rate for Payer: United Healthcare Commercial |
$1,311.22
|
| Rate for Payer: United Healthcare Medicare |
$782.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,345.54
|
| Rate for Payer: Wise Provider Network Commercial |
$1,304.35
|
|
|
HC BLOOD TRANSFUSION SERVICE EACH ADDITIONAL UNIT
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$855.57 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,042.80
|
| Rate for Payer: Altius Commercial |
$1,516.80
|
| Rate for Payer: Beech Street Commercial |
$1,548.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,532.60
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
| Rate for Payer: Entrust Commercial |
$1,501.00
|
| Rate for Payer: First Choice Health Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$900.60
|
| Rate for Payer: HealthUtah PPO |
$1,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
| Rate for Payer: Multiplan Medicare/VA |
$855.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
| Rate for Payer: PacificSource Commercial |
$1,422.00
|
| Rate for Payer: PHCS PPO |
$1,548.40
|
| Rate for Payer: Three Rivers PPO |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration |
$900.60
|
| Rate for Payer: United Healthcare Commercial |
$1,508.90
|
| Rate for Payer: United Healthcare Medicare |
$900.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,548.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
|
HC BLOOD TRANSFUSION SERVICE EACH ADDITIONAL UNIT
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,011.20
|
| Rate for Payer: Altius Commercial |
$1,516.80
|
| Rate for Payer: Beech Street Commercial |
$1,548.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,532.60
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
| Rate for Payer: Entrust Commercial |
$1,501.00
|
| Rate for Payer: First Choice Health Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$963.80
|
| Rate for Payer: HealthUtah PPO |
$1,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
| Rate for Payer: Multiplan Medicare/VA |
$915.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
| Rate for Payer: PacificSource Commercial |
$1,422.00
|
| Rate for Payer: PHCS PPO |
$1,548.40
|
| Rate for Payer: Three Rivers PPO |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration |
$963.80
|
| Rate for Payer: United Healthcare Commercial |
$1,508.90
|
| Rate for Payer: United Healthcare Medicare |
$963.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,501.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
|
HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.66 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$287.14
|
| Rate for Payer: Aetna of WY Medicare |
$193.38
|
| Rate for Payer: Altius Commercial |
$281.28
|
| Rate for Payer: Beech Street Commercial |
$287.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.21
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$284.21
|
| Rate for Payer: Cigna of WY Commercial |
$287.14
|
| Rate for Payer: Entrust Commercial |
$278.35
|
| Rate for Payer: First Choice Health Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.01
|
| Rate for Payer: HealthUtah PPO |
$293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$284.21
|
| Rate for Payer: Multiplan Medicare/VA |
$158.66
|
| Rate for Payer: One Health Plan of WY PPO |
$287.14
|
| Rate for Payer: PacificSource Commercial |
$263.70
|
| Rate for Payer: PHCS PPO |
$287.14
|
| Rate for Payer: Three Rivers PPO |
$219.75
|
| Rate for Payer: TriWest Veterans Administration |
$167.01
|
| Rate for Payer: United Healthcare Commercial |
$279.82
|
| Rate for Payer: United Healthcare Medicare |
$167.01
|
| Rate for Payer: WINHealth Partners Commercial |
$287.14
|
| Rate for Payer: Wise Provider Network Commercial |
$278.35
|
|
|
HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.79 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$287.14
|
| Rate for Payer: Aetna of WY Medicare |
$187.52
|
| Rate for Payer: Altius Commercial |
$281.28
|
| Rate for Payer: Beech Street Commercial |
$287.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.21
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$284.21
|
| Rate for Payer: Cigna of WY Commercial |
$287.14
|
| Rate for Payer: Entrust Commercial |
$278.35
|
| Rate for Payer: First Choice Health Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.73
|
| Rate for Payer: HealthUtah PPO |
$293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$284.21
|
| Rate for Payer: Multiplan Medicare/VA |
$169.79
|
| Rate for Payer: One Health Plan of WY PPO |
$287.14
|
| Rate for Payer: PacificSource Commercial |
$263.70
|
| Rate for Payer: PHCS PPO |
$287.14
|
| Rate for Payer: Three Rivers PPO |
$219.75
|
| Rate for Payer: TriWest Veterans Administration |
$178.73
|
| Rate for Payer: United Healthcare Commercial |
$279.82
|
| Rate for Payer: United Healthcare Medicare |
$178.73
|
| Rate for Payer: WINHealth Partners Commercial |
$278.35
|
| Rate for Payer: Wise Provider Network Commercial |
$278.35
|
|
|
HC BLOOD TYPING SEROLOGIC ABO
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.98 |
| 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 Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.40
|
| 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 |
$68.40
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$64.98
|
| 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 |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$68.40
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC BLOOD TYPING SEROLOGIC ABO
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$76.80
|
| 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 |
$116.40
|
| 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 |
$73.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$69.54
|
| 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 |
$73.20
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Aetna of WY Medicare |
$61.38
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.21
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.01
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$50.36
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.01
|
| Rate for Payer: United Healthcare Commercial |
$88.82
|
| Rate for Payer: United Healthcare Medicare |
$53.01
|
| Rate for Payer: WINHealth Partners Commercial |
$91.14
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Aetna of WY Medicare |
$59.52
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.21
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.73
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$53.89
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.73
|
| Rate for Payer: United Healthcare Commercial |
$88.82
|
| Rate for Payer: United Healthcare Medicare |
$56.73
|
| Rate for Payer: WINHealth Partners Commercial |
$88.35
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$71.04
|
| 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 |
$67.71
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$64.32
|
| 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 |
$67.71
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$67.71
|
| Rate for Payer: WINHealth Partners Commercial |
$105.45
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Aetna of WY Medicare |
$110.72
|
| Rate for Payer: Altius Commercial |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$169.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: Entrust Commercial |
$164.35
|
| Rate for Payer: First Choice Health Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.53
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: Multiplan Medicare/VA |
$100.25
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$169.54
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: TriWest Veterans Administration |
$105.53
|
| Rate for Payer: United Healthcare Commercial |
$165.22
|
| Rate for Payer: United Healthcare Medicare |
$105.53
|
| Rate for Payer: WINHealth Partners Commercial |
$164.35
|
| Rate for Payer: Wise Provider Network Commercial |
$164.35
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.68 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Aetna of WY Medicare |
$114.18
|
| Rate for Payer: Altius Commercial |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$169.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: Entrust Commercial |
$164.35
|
| Rate for Payer: First Choice Health Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.61
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: Multiplan Medicare/VA |
$93.68
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$169.54
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.61
|
| Rate for Payer: United Healthcare Commercial |
$165.22
|
| Rate for Payer: United Healthcare Medicare |
$98.61
|
| Rate for Payer: WINHealth Partners Commercial |
$169.54
|
| Rate for Payer: Wise Provider Network Commercial |
$164.35
|
|
|
HC BONE BIOPSY,TROCAR/NEEDLE DEEP
|
Facility
|
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
3502022501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,853.10 |
| Max. Negotiated Rate |
$6,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,516.02
|
| Rate for Payer: Aetna of WY Medicare |
$4,255.36
|
| Rate for Payer: Altius Commercial |
$6,383.04
|
| Rate for Payer: Beech Street Commercial |
$6,516.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,449.53
|
| Rate for Payer: Cash Price |
$4,654.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,449.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,516.02
|
| Rate for Payer: Entrust Commercial |
$6,316.55
|
| Rate for Payer: First Choice Health Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,055.89
|
| Rate for Payer: HealthUtah PPO |
$6,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,449.53
|
| Rate for Payer: Multiplan Medicare/VA |
$3,853.10
|
| Rate for Payer: One Health Plan of WY PPO |
$6,516.02
|
| Rate for Payer: PacificSource Commercial |
$5,984.10
|
| Rate for Payer: PHCS PPO |
$6,516.02
|
| Rate for Payer: Three Rivers PPO |
$4,986.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,055.89
|
| Rate for Payer: United Healthcare Commercial |
$6,349.80
|
| Rate for Payer: United Healthcare Medicare |
$4,055.89
|
| Rate for Payer: WINHealth Partners Commercial |
$6,316.55
|
| Rate for Payer: Wise Provider Network Commercial |
$6,316.55
|
|
|
HC BONE BIOPSY,TROCAR/NEEDLE DEEP
|
Facility
|
OP
|
$6,649.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
3502022501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,600.43 |
| Max. Negotiated Rate |
$6,649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,516.02
|
| Rate for Payer: Aetna of WY Medicare |
$4,388.34
|
| Rate for Payer: Altius Commercial |
$6,383.04
|
| Rate for Payer: Beech Street Commercial |
$6,516.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,449.53
|
| Rate for Payer: Cash Price |
$4,654.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,449.53
|
| Rate for Payer: Cigna of WY Commercial |
$6,516.02
|
| Rate for Payer: Entrust Commercial |
$6,316.55
|
| Rate for Payer: First Choice Health Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,316.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,789.93
|
| Rate for Payer: HealthUtah PPO |
$6,649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,449.53
|
| Rate for Payer: Multiplan Medicare/VA |
$3,600.43
|
| Rate for Payer: One Health Plan of WY PPO |
$6,516.02
|
| Rate for Payer: PacificSource Commercial |
$5,984.10
|
| Rate for Payer: PHCS PPO |
$6,516.02
|
| Rate for Payer: Three Rivers PPO |
$4,986.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,789.93
|
| Rate for Payer: United Healthcare Commercial |
$6,349.80
|
| Rate for Payer: United Healthcare Medicare |
$3,789.93
|
| Rate for Payer: WINHealth Partners Commercial |
$6,516.02
|
| Rate for Payer: Wise Provider Network Commercial |
$6,316.55
|
|
