|
HC CLOSE TX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
7612672001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSE TX PROX/MID FING SHFT FX,MANIP
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
7612672501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSE TX PROX/MID FING SHFT FX,MANIP
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
7612672501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSURE SUPERF WND DEHIS SIMPLE
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
7611202001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSURE SUPERF WND DEHIS SIMPLE
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
7611202001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSURE SUPERF WND DEHIS W PACKING
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
5101202101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.49
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$63.17
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.49
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$66.49
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CLOSURE SUPERF WND DEHIS W PACKING
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
5101202101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.13
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$59.02
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.13
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC CLOSURE SUPERF WND DEHIS W PACKING
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
7611202101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSURE SUPERF WND DEHIS W PACKING
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
7611202101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3058521001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$52.48
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.02
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$47.52
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$50.02
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Medicare |
$50.02
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
3058521001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$54.12
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.74
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$44.40
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Medicare |
$46.74
|
| Rate for Payer: WINHealth Partners Commercial |
$80.36
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
3058525001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$139.17 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.86
|
| Rate for Payer: Aetna of WY Medicare |
$169.62
|
| Rate for Payer: Altius Commercial |
$246.72
|
| Rate for Payer: Beech Street Commercial |
$251.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$249.29
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$249.29
|
| Rate for Payer: Cigna of WY Commercial |
$251.86
|
| Rate for Payer: Entrust Commercial |
$244.15
|
| Rate for Payer: First Choice Health Commercial |
$244.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.49
|
| Rate for Payer: HealthUtah PPO |
$257.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.29
|
| Rate for Payer: Multiplan Medicare/VA |
$139.17
|
| Rate for Payer: One Health Plan of WY PPO |
$251.86
|
| Rate for Payer: PacificSource Commercial |
$231.30
|
| Rate for Payer: PHCS PPO |
$251.86
|
| Rate for Payer: Three Rivers PPO |
$192.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.49
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
| Rate for Payer: United Healthcare Medicare |
$146.49
|
| Rate for Payer: WINHealth Partners Commercial |
$251.86
|
| Rate for Payer: Wise Provider Network Commercial |
$244.15
|
|
|
HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
3058525001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.86
|
| Rate for Payer: Aetna of WY Medicare |
$164.48
|
| Rate for Payer: Altius Commercial |
$246.72
|
| Rate for Payer: Beech Street Commercial |
$251.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$249.29
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$249.29
|
| Rate for Payer: Cigna of WY Commercial |
$251.86
|
| Rate for Payer: Entrust Commercial |
$244.15
|
| Rate for Payer: First Choice Health Commercial |
$244.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.77
|
| Rate for Payer: HealthUtah PPO |
$257.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.29
|
| Rate for Payer: Multiplan Medicare/VA |
$148.93
|
| Rate for Payer: One Health Plan of WY PPO |
$251.86
|
| Rate for Payer: PacificSource Commercial |
$231.30
|
| Rate for Payer: PHCS PPO |
$251.86
|
| Rate for Payer: Three Rivers PPO |
$192.75
|
| Rate for Payer: TriWest Veterans Administration |
$156.77
|
| Rate for Payer: United Healthcare Commercial |
$245.44
|
| Rate for Payer: United Healthcare Medicare |
$156.77
|
| Rate for Payer: WINHealth Partners Commercial |
$244.15
|
| Rate for Payer: Wise Provider Network Commercial |
$244.15
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR 8 ACTIVITY
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3058524001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$140.16
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$212.43
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.59
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$126.91
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$133.59
|
| Rate for Payer: United Healthcare Commercial |
$209.14
|
| Rate for Payer: United Healthcare Medicare |
$133.59
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC CLOT FACTOR VIII AHG 1 STAGE - FACTOR 8 ACTIVITY
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
3058524001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$144.54
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$212.43
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.83
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$118.59
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.83
|
| Rate for Payer: United Healthcare Commercial |
$209.14
|
| Rate for Payer: United Healthcare Medicare |
$124.83
|
| Rate for Payer: WINHealth Partners Commercial |
$214.62
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$126.72
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.44
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$103.97
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.44
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$109.44
|
| Rate for Payer: WINHealth Partners Commercial |
$188.16
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
3058524603
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$122.88
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.12
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$111.26
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.12
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$117.12
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$168.41 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$304.78
|
| Rate for Payer: Aetna of WY Medicare |
$205.26
|
| Rate for Payer: Altius Commercial |
$298.56
|
| Rate for Payer: Beech Street Commercial |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.67
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$301.67
|
| Rate for Payer: Cigna of WY Commercial |
$304.78
|
| Rate for Payer: Entrust Commercial |
$295.45
|
| Rate for Payer: First Choice Health Commercial |
$295.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$295.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.27
|
| Rate for Payer: HealthUtah PPO |
$311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$301.67
|
| Rate for Payer: Multiplan Medicare/VA |
$168.41
|
| Rate for Payer: One Health Plan of WY PPO |
$304.78
|
| Rate for Payer: PacificSource Commercial |
$279.90
|
| Rate for Payer: PHCS PPO |
$304.78
|
| Rate for Payer: Three Rivers PPO |
$233.25
|
| Rate for Payer: TriWest Veterans Administration |
$177.27
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Medicare |
$177.27
|
| Rate for Payer: WINHealth Partners Commercial |
$304.78
|
| Rate for Payer: Wise Provider Network Commercial |
$295.45
|
|
|
HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
3058524501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$180.22 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$304.78
|
| Rate for Payer: Aetna of WY Medicare |
$199.04
|
| Rate for Payer: Altius Commercial |
$298.56
|
| Rate for Payer: Beech Street Commercial |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$301.67
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$301.67
|
| Rate for Payer: Cigna of WY Commercial |
$304.78
|
| Rate for Payer: Entrust Commercial |
$295.45
|
| Rate for Payer: First Choice Health Commercial |
$295.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$295.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.71
|
| Rate for Payer: HealthUtah PPO |
$311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$301.67
|
| Rate for Payer: Multiplan Medicare/VA |
$180.22
|
| Rate for Payer: One Health Plan of WY PPO |
$304.78
|
| Rate for Payer: PacificSource Commercial |
$279.90
|
| Rate for Payer: PHCS PPO |
$304.78
|
| Rate for Payer: Three Rivers PPO |
$233.25
|
| Rate for Payer: TriWest Veterans Administration |
$189.71
|
| Rate for Payer: United Healthcare Commercial |
$297.00
|
| Rate for Payer: United Healthcare Medicare |
$189.71
|
| Rate for Payer: WINHealth Partners Commercial |
$295.45
|
| Rate for Payer: Wise Provider Network Commercial |
$295.45
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$82.85 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$100.98
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.41
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.21
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$82.85
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.21
|
| Rate for Payer: United Healthcare Commercial |
$146.12
|
| Rate for Payer: United Healthcare Medicare |
$87.21
|
| Rate for Payer: WINHealth Partners Commercial |
$149.94
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
3058523001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$97.92
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.41
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.33
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$88.66
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.33
|
| Rate for Payer: United Healthcare Commercial |
$146.12
|
| Rate for Payer: United Healthcare Medicare |
$93.33
|
| Rate for Payer: WINHealth Partners Commercial |
$145.35
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
3058526001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.90 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$71.68
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.32
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$64.90
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.32
|
| Rate for Payer: United Healthcare Commercial |
$106.96
|
| Rate for Payer: United Healthcare Medicare |
$68.32
|
| Rate for Payer: WINHealth Partners Commercial |
$106.40
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
3058526001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$73.92
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.84
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$60.65
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.84
|
| Rate for Payer: United Healthcare Commercial |
$106.96
|
| Rate for Payer: United Healthcare Medicare |
$63.84
|
| Rate for Payer: WINHealth Partners Commercial |
$109.76
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| 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 CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
3058530301
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
