|
HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 96402
|
| Hospital Charge Code |
3319640201
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$327.32
|
| Rate for Payer: Aetna of WY Medicare |
$213.76
|
| Rate for Payer: Altius Commercial |
$320.64
|
| Rate for Payer: Beech Street Commercial |
$327.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$323.98
|
| Rate for Payer: Cash Price |
$233.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.98
|
| Rate for Payer: Cigna of WY Commercial |
$327.32
|
| Rate for Payer: Entrust Commercial |
$317.30
|
| Rate for Payer: First Choice Health Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.74
|
| Rate for Payer: HealthUtah PPO |
$334.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.98
|
| Rate for Payer: Multiplan Medicare/VA |
$193.55
|
| Rate for Payer: One Health Plan of WY PPO |
$327.32
|
| Rate for Payer: PacificSource Commercial |
$300.60
|
| Rate for Payer: PHCS PPO |
$327.32
|
| Rate for Payer: Three Rivers PPO |
$250.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.74
|
| Rate for Payer: United Healthcare Commercial |
$318.97
|
| Rate for Payer: United Healthcare Medicare |
$203.74
|
| Rate for Payer: WINHealth Partners Commercial |
$317.30
|
| Rate for Payer: Wise Provider Network Commercial |
$317.30
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$249.76 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$275.84
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.07
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.91
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$249.76
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$262.91
|
| Rate for Payer: United Healthcare Commercial |
$411.60
|
| Rate for Payer: United Healthcare Medicare |
$262.91
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3359641701
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$233.39 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$284.46
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.07
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.67
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$233.39
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$245.67
|
| Rate for Payer: United Healthcare Commercial |
$411.60
|
| Rate for Payer: United Healthcare Medicare |
$245.67
|
| Rate for Payer: WINHealth Partners Commercial |
$422.38
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$387.69 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$655.62
|
| Rate for Payer: Aetna of WY Medicare |
$428.16
|
| Rate for Payer: Altius Commercial |
$642.24
|
| Rate for Payer: Beech Street Commercial |
$655.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$648.93
|
| Rate for Payer: Cash Price |
$468.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$648.93
|
| Rate for Payer: Cigna of WY Commercial |
$655.62
|
| Rate for Payer: Entrust Commercial |
$635.55
|
| Rate for Payer: First Choice Health Commercial |
$635.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$635.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.09
|
| Rate for Payer: HealthUtah PPO |
$669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$648.93
|
| Rate for Payer: Multiplan Medicare/VA |
$387.69
|
| Rate for Payer: One Health Plan of WY PPO |
$655.62
|
| Rate for Payer: PacificSource Commercial |
$602.10
|
| Rate for Payer: PHCS PPO |
$655.62
|
| Rate for Payer: Three Rivers PPO |
$501.75
|
| Rate for Payer: TriWest Veterans Administration |
$408.09
|
| Rate for Payer: United Healthcare Commercial |
$638.90
|
| Rate for Payer: United Healthcare Medicare |
$408.09
|
| Rate for Payer: WINHealth Partners Commercial |
$635.55
|
| Rate for Payer: Wise Provider Network Commercial |
$635.55
|
|
|
HC CHEMOTHER, IV INFUSION, 1 HR
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3359641301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$362.26 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$655.62
|
| Rate for Payer: Aetna of WY Medicare |
$441.54
|
| Rate for Payer: Altius Commercial |
$642.24
|
| Rate for Payer: Beech Street Commercial |
$655.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$648.93
|
| Rate for Payer: Cash Price |
$468.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$648.93
|
| Rate for Payer: Cigna of WY Commercial |
$655.62
|
| Rate for Payer: Entrust Commercial |
$635.55
|
| Rate for Payer: First Choice Health Commercial |
$635.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$635.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$381.33
|
| Rate for Payer: HealthUtah PPO |
$669.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$648.93
|
| Rate for Payer: Multiplan Medicare/VA |
$362.26
|
| Rate for Payer: One Health Plan of WY PPO |
$655.62
|
| Rate for Payer: PacificSource Commercial |
$602.10
|
| Rate for Payer: PHCS PPO |
$655.62
|
| Rate for Payer: Three Rivers PPO |
$501.75
|
| Rate for Payer: TriWest Veterans Administration |
$381.33
|
| Rate for Payer: United Healthcare Commercial |
$638.90
|
| Rate for Payer: United Healthcare Medicare |
$381.33
|
| Rate for Payer: WINHealth Partners Commercial |
$655.62
|
| Rate for Payer: Wise Provider Network Commercial |
$635.55
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$354.07 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$598.78
|
| Rate for Payer: Aetna of WY Medicare |
$391.04
|
| Rate for Payer: Altius Commercial |
$586.56
|
| Rate for Payer: Beech Street Commercial |
$598.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$592.67
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$592.67
|
| Rate for Payer: Cigna of WY Commercial |
$598.78
|
| Rate for Payer: Entrust Commercial |
$580.45
|
| Rate for Payer: First Choice Health Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.71
|
| Rate for Payer: HealthUtah PPO |
$611.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$592.67
|
| Rate for Payer: Multiplan Medicare/VA |
$354.07
|
| Rate for Payer: One Health Plan of WY PPO |
$598.78
|
| Rate for Payer: PacificSource Commercial |
$549.90
|
| Rate for Payer: PHCS PPO |
$598.78
|
| Rate for Payer: Three Rivers PPO |
$458.25
|
| Rate for Payer: TriWest Veterans Administration |
$372.71
|
| Rate for Payer: United Healthcare Commercial |
$583.50
|
| Rate for Payer: United Healthcare Medicare |
$372.71
|
| Rate for Payer: WINHealth Partners Commercial |
$580.45
|
| Rate for Payer: Wise Provider Network Commercial |
$580.45
|
|
|
HC CHEMOTHER, IV INFUSION, EA ADD HR
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3359641501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$330.86 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$598.78
|
| Rate for Payer: Aetna of WY Medicare |
$403.26
|
| Rate for Payer: Altius Commercial |
$586.56
|
| Rate for Payer: Beech Street Commercial |
$598.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$592.67
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$592.67
|
| Rate for Payer: Cigna of WY Commercial |
$598.78
|
| Rate for Payer: Entrust Commercial |
$580.45
|
| Rate for Payer: First Choice Health Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.27
|
| Rate for Payer: HealthUtah PPO |
$611.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$592.67
|
| Rate for Payer: Multiplan Medicare/VA |
$330.86
|
| Rate for Payer: One Health Plan of WY PPO |
$598.78
|
| Rate for Payer: PacificSource Commercial |
$549.90
|
| Rate for Payer: PHCS PPO |
$598.78
|
| Rate for Payer: Three Rivers PPO |
$458.25
|
| Rate for Payer: TriWest Veterans Administration |
$348.27
|
| Rate for Payer: United Healthcare Commercial |
$583.50
|
| Rate for Payer: United Healthcare Medicare |
$348.27
|
| Rate for Payer: WINHealth Partners Commercial |
$598.78
|
| Rate for Payer: Wise Provider Network Commercial |
$580.45
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3359641101
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$206.31 |
| Max. Negotiated Rate |
$381.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$373.38
|
| Rate for Payer: Aetna of WY Medicare |
$251.46
|
| Rate for Payer: Altius Commercial |
$365.76
|
| Rate for Payer: Beech Street Commercial |
$373.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.57
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$369.57
|
| Rate for Payer: Cigna of WY Commercial |
$373.38
|
| Rate for Payer: Entrust Commercial |
$361.95
|
| Rate for Payer: First Choice Health Commercial |
$361.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.17
|
| Rate for Payer: HealthUtah PPO |
$381.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$369.57
|
| Rate for Payer: Multiplan Medicare/VA |
$206.31
|
| Rate for Payer: One Health Plan of WY PPO |
$373.38
|
| Rate for Payer: PacificSource Commercial |
$342.90
|
| Rate for Payer: PHCS PPO |
$373.38
|
| Rate for Payer: Three Rivers PPO |
$285.75
|
| Rate for Payer: TriWest Veterans Administration |
$217.17
|
| Rate for Payer: United Healthcare Commercial |
$363.86
|
| Rate for Payer: United Healthcare Medicare |
$217.17
|
| Rate for Payer: WINHealth Partners Commercial |
$373.38
|
| Rate for Payer: Wise Provider Network Commercial |
$361.95
|
|
|
HC CHEMOTHER, IV PUSH,EA ADD DRUG
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3359641101
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$220.79 |
| Max. Negotiated Rate |
$381.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$373.38
|
| Rate for Payer: Aetna of WY Medicare |
$243.84
|
| Rate for Payer: Altius Commercial |
$365.76
|
| Rate for Payer: Beech Street Commercial |
$373.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.57
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$369.57
|
| Rate for Payer: Cigna of WY Commercial |
$373.38
|
| Rate for Payer: Entrust Commercial |
$361.95
|
| Rate for Payer: First Choice Health Commercial |
$361.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.41
|
| Rate for Payer: HealthUtah PPO |
$381.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$369.57
|
| Rate for Payer: Multiplan Medicare/VA |
$220.79
|
| Rate for Payer: One Health Plan of WY PPO |
$373.38
|
| Rate for Payer: PacificSource Commercial |
$342.90
|
| Rate for Payer: PHCS PPO |
$373.38
|
| Rate for Payer: Three Rivers PPO |
$285.75
|
| Rate for Payer: TriWest Veterans Administration |
$232.41
|
| Rate for Payer: United Healthcare Commercial |
$363.86
|
| Rate for Payer: United Healthcare Medicare |
$232.41
|
| Rate for Payer: WINHealth Partners Commercial |
$361.95
|
| Rate for Payer: Wise Provider Network Commercial |
$361.95
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
3359640901
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$265.88 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$324.06
|
| Rate for Payer: Altius Commercial |
$471.36
|
| Rate for Payer: Beech Street Commercial |
$481.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.27
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: Entrust Commercial |
$466.45
|
| Rate for Payer: First Choice Health Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.87
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$265.88
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$481.18
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$279.87
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Medicare |
$279.87
|
| Rate for Payer: WINHealth Partners Commercial |
$481.18
|
| Rate for Payer: Wise Provider Network Commercial |
$466.45
|
|
|
HC CHEMOTHER, IV PUSH, SNGL DRUG
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
3359640901
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$284.53 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$314.24
|
| Rate for Payer: Altius Commercial |
$471.36
|
| Rate for Payer: Beech Street Commercial |
$481.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.27
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: Entrust Commercial |
$466.45
|
| Rate for Payer: First Choice Health Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.51
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$284.53
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$481.18
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$299.51
|
| Rate for Payer: United Healthcare Commercial |
$468.90
|
| Rate for Payer: United Healthcare Medicare |
$299.51
|
| Rate for Payer: WINHealth Partners Commercial |
$466.45
|
| Rate for Payer: Wise Provider Network Commercial |
$466.45
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$151.08 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.42
|
| Rate for Payer: Aetna of WY Medicare |
$184.14
|
| Rate for Payer: Altius Commercial |
$267.84
|
| Rate for Payer: Beech Street Commercial |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.63
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$270.63
|
| Rate for Payer: Cigna of WY Commercial |
$273.42
|
| Rate for Payer: Entrust Commercial |
$265.05
|
| Rate for Payer: First Choice Health Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.03
|
| Rate for Payer: HealthUtah PPO |
$279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$270.63
|
| Rate for Payer: Multiplan Medicare/VA |
$151.08
|
| Rate for Payer: One Health Plan of WY PPO |
$273.42
|
| Rate for Payer: PacificSource Commercial |
$251.10
|
| Rate for Payer: PHCS PPO |
$273.42
|
| Rate for Payer: Three Rivers PPO |
$209.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.03
|
| Rate for Payer: United Healthcare Commercial |
$266.44
|
| Rate for Payer: United Healthcare Medicare |
$159.03
|
| Rate for Payer: WINHealth Partners Commercial |
$273.42
|
| Rate for Payer: Wise Provider Network Commercial |
$265.05
|
|
|
HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
3319640101
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.42
|
| Rate for Payer: Aetna of WY Medicare |
$178.56
|
| Rate for Payer: Altius Commercial |
$267.84
|
| Rate for Payer: Beech Street Commercial |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.63
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$270.63
|
| Rate for Payer: Cigna of WY Commercial |
$273.42
|
| Rate for Payer: Entrust Commercial |
$265.05
|
| Rate for Payer: First Choice Health Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.19
|
| Rate for Payer: HealthUtah PPO |
$279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$270.63
|
| Rate for Payer: Multiplan Medicare/VA |
$161.68
|
| Rate for Payer: One Health Plan of WY PPO |
$273.42
|
| Rate for Payer: PacificSource Commercial |
$251.10
|
| Rate for Payer: PHCS PPO |
$273.42
|
| Rate for Payer: Three Rivers PPO |
$209.25
|
| Rate for Payer: TriWest Veterans Administration |
$170.19
|
| Rate for Payer: United Healthcare Commercial |
$266.44
|
| Rate for Payer: United Healthcare Medicare |
$170.19
|
| Rate for Payer: WINHealth Partners Commercial |
$265.05
|
| Rate for Payer: Wise Provider Network Commercial |
$265.05
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$530.82 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$897.68
|
| Rate for Payer: Aetna of WY Medicare |
$586.24
|
| Rate for Payer: Altius Commercial |
$879.36
|
| Rate for Payer: Beech Street Commercial |
$897.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$888.52
|
| Rate for Payer: Cash Price |
$641.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$888.52
|
| Rate for Payer: Cigna of WY Commercial |
$897.68
|
| Rate for Payer: Entrust Commercial |
$870.20
|
| Rate for Payer: First Choice Health Commercial |
$870.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$870.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$558.76
|
| Rate for Payer: HealthUtah PPO |
$916.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$888.52
|
| Rate for Payer: Multiplan Medicare/VA |
$530.82
|
| Rate for Payer: One Health Plan of WY PPO |
$897.68
|
| Rate for Payer: PacificSource Commercial |
$824.40
|
| Rate for Payer: PHCS PPO |
$897.68
|
| Rate for Payer: Three Rivers PPO |
$687.00
|
| Rate for Payer: TriWest Veterans Administration |
$558.76
|
| Rate for Payer: United Healthcare Commercial |
$874.78
|
| Rate for Payer: United Healthcare Medicare |
$558.76
|
| Rate for Payer: WINHealth Partners Commercial |
$870.20
|
| Rate for Payer: Wise Provider Network Commercial |
$870.20
|
|
|
HC CHEMOTHER PROLONG INFUSE W/PUMP
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
3359641601
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$496.01 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$897.68
|
| Rate for Payer: Aetna of WY Medicare |
$604.56
|
| Rate for Payer: Altius Commercial |
$879.36
|
| Rate for Payer: Beech Street Commercial |
$897.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$888.52
|
| Rate for Payer: Cash Price |
$641.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$888.52
|
| Rate for Payer: Cigna of WY Commercial |
$897.68
|
| Rate for Payer: Entrust Commercial |
$870.20
|
| Rate for Payer: First Choice Health Commercial |
$870.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$870.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.12
|
| Rate for Payer: HealthUtah PPO |
$916.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$888.52
|
| Rate for Payer: Multiplan Medicare/VA |
$496.01
|
| Rate for Payer: One Health Plan of WY PPO |
$897.68
|
| Rate for Payer: PacificSource Commercial |
$824.40
|
| Rate for Payer: PHCS PPO |
$897.68
|
| Rate for Payer: Three Rivers PPO |
$687.00
|
| Rate for Payer: TriWest Veterans Administration |
$522.12
|
| Rate for Payer: United Healthcare Commercial |
$874.78
|
| Rate for Payer: United Healthcare Medicare |
$522.12
|
| Rate for Payer: WINHealth Partners Commercial |
$897.68
|
| Rate for Payer: Wise Provider Network Commercial |
$870.20
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
2603659201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.93
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$80.68
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.93
|
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: United Healthcare Medicare |
$84.93
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
3003659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$174.72
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.53
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$158.20
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.53
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$166.53
|
| Rate for Payer: WINHealth Partners Commercial |
$259.35
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
3003659201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$180.18
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.61
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$147.83
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$155.61
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$155.61
|
| Rate for Payer: WINHealth Partners Commercial |
$267.54
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC CHG COLLECT BLOOD FROM CATHETER VENOUS NOS
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
2603659201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.89
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$86.35
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$90.89
|
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: United Healthcare Medicare |
$90.89
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| 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 CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| 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 CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.24 |
| 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 Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.10
|
| 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 |
$17.10
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.24
|
| 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 |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$17.10
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.20
|
| 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 |
$29.10
|
| 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 |
$18.30
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$17.38
|
| 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 |
$18.30
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$18.30
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
9833641501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.96 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$132.48
|
| Rate for Payer: Altius Commercial |
$198.72
|
| Rate for Payer: Beech Street Commercial |
$202.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$200.79
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: Entrust Commercial |
$196.65
|
| Rate for Payer: First Choice Health Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.27
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$119.96
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$202.86
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.27
|
| Rate for Payer: United Healthcare Commercial |
$197.68
|
| Rate for Payer: United Healthcare Medicare |
$126.27
|
| Rate for Payer: WINHealth Partners Commercial |
$196.65
|
| Rate for Payer: Wise Provider Network Commercial |
$196.65
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
9833641501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$112.09 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$136.62
|
| Rate for Payer: Altius Commercial |
$198.72
|
| Rate for Payer: Beech Street Commercial |
$202.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$200.79
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: Entrust Commercial |
$196.65
|
| Rate for Payer: First Choice Health Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.99
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$112.09
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$202.86
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$117.99
|
| Rate for Payer: United Healthcare Commercial |
$197.68
|
| Rate for Payer: United Healthcare Medicare |
$117.99
|
| Rate for Payer: WINHealth Partners Commercial |
$202.86
|
| Rate for Payer: Wise Provider Network Commercial |
$196.65
|
|
