|
HC HEAL & BEHAV ASSESSMENT INDIVIDUAL ADD 15 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 96159
|
| Hospital Charge Code |
9009615901
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC HEAL & BEHAV ASSESSMENT INDIVIDUAL ADD 15 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 96159
|
| Hospital Charge Code |
9009615901
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: Optum Behavioral Health Commercial |
$20.33
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC HEAL & BEHAV ASSESSMENT/RE-ASSESSMENT
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 96156
|
| Hospital Charge Code |
9009615601
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC HEAL & BEHAV ASSESSMENT/RE-ASSESSMENT
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 96156
|
| Hospital Charge Code |
9009615601
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: Optum Behavioral Health Commercial |
$86.86
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC HELICOBACTER PYLORI - HELICOBACTER PYLORI IGA
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3028667701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC HELICOBACTER PYLORI - HELICOBACTER PYLORI IGA
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3028667701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC HELMINTH, ANTIBODY - ECHINOCOCCUS ANTIBODY, IGG
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HELMINTH, ANTIBODY - ECHINOCOCCUS ANTIBODY, IGG
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HELMINTH, ANTIBODY - STRONGYLOIDES ANTIBODY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668206
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HELMINTH, ANTIBODY - STRONGYLOIDES ANTIBODY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668206
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HELMINTH, ANTIBODY - TOXACARA ANTIBODY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HELMINTH, ANTIBODY - TOXACARA ANTIBODY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
3028668205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC HEMAGGLUTINATION INHIBITION - HEMAGGLUTINATION INHIBITION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86280
|
| Hospital Charge Code |
3028628001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC HEMAGGLUTINATION INHIBITION - HEMAGGLUTINATION INHIBITION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86280
|
| Hospital Charge Code |
3028628001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.20
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$49.59
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$52.20
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.40
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.43
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBINOPATHY EVAL
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
3018302101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBINOPATHY EVAL
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
3018302101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
3018302001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
3018302001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3058546001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3058546001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC HEMOPHILUS INFLUENZA - HAEMOPHILUS INFLUENZAE B AB IGG
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86684
|
| Hospital Charge Code |
3028668401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
