|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
2609636501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
7619636501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
7619636501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.60
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$176.32
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.60
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$185.60
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
2609636601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$307.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$262.72
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$200.64
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$211.20
|
| Rate for Payer: United Healthcare Commercial |
$278.40
|
| Rate for Payer: United Healthcare Medicare |
$211.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
5109636501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
5109636501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC IV REGIONAL BLOCK SET UP
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
3700000004
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC IV REGIONAL BLOCK SET UP
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
3700000004
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC IV SEDATION OR MAC SET UP
|
Facility
|
IP
|
$185.00
|
|
| Hospital Charge Code |
3700000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC IV SEDATION OR MAC SET UP
|
Facility
|
OP
|
$185.00
|
|
| Hospital Charge Code |
3700000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC JAK2 GENE ANAL - JAK 2 MUTATION
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
3108127001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$396.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$330.60
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$348.00
|
| Rate for Payer: WINHealth Partners Commercial |
$588.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC JAK2 GENE ANAL - JAK 2 MUTATION
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
3108127001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$376.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$376.20
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
| Rate for Payer: WINHealth Partners Commercial |
$570.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC JCV ANTIBODY
|
Facility
|
OP
|
$2,960.00
|
|
| Hospital Charge Code |
3000000023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,630.96 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,900.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,953.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,841.60
|
| Rate for Payer: Altius Commercial |
$2,841.60
|
| Rate for Payer: Beech Street Commercial |
$2,900.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,430.16
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,871.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,900.80
|
| Rate for Payer: Entrust Commercial |
$2,812.00
|
| Rate for Payer: First Choice Health Commercial |
$2,812.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,812.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,716.80
|
| Rate for Payer: HealthUtah PPO |
$2,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,871.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,630.96
|
| Rate for Payer: One Health Plan of WY PPO |
$2,900.80
|
| Rate for Payer: PacificSource Commercial |
$2,664.00
|
| Rate for Payer: PHCS PPO |
$2,900.80
|
| Rate for Payer: Three Rivers PPO |
$2,220.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,716.80
|
| Rate for Payer: United Healthcare Commercial |
$2,575.20
|
| Rate for Payer: United Healthcare Medicare |
$1,716.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,900.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,812.00
|
|
|
HC JCV ANTIBODY
|
Facility
|
IP
|
$2,960.00
|
|
| Hospital Charge Code |
3000000023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,855.92 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,900.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,841.60
|
| Rate for Payer: Altius Commercial |
$2,841.60
|
| Rate for Payer: Beech Street Commercial |
$2,900.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,430.16
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,871.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,900.80
|
| Rate for Payer: Entrust Commercial |
$2,812.00
|
| Rate for Payer: First Choice Health Commercial |
$2,812.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,812.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,953.60
|
| Rate for Payer: HealthUtah PPO |
$2,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,871.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,855.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,900.80
|
| Rate for Payer: PacificSource Commercial |
$2,664.00
|
| Rate for Payer: PHCS PPO |
$2,900.80
|
| Rate for Payer: Three Rivers PPO |
$2,220.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,953.60
|
| Rate for Payer: United Healthcare Commercial |
$2,575.20
|
| Rate for Payer: United Healthcare Medicare |
$1,953.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,812.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,812.00
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$801.70 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Aetna of WY Medicare |
$960.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.90
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$801.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.90
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$843.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$912.28 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$960.30
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$912.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$960.30
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$960.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,382.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC K FLOW/FUNCT IMAGE W/DRUG - NM KIDNEY FLOW/FUNCTION WITH DIURETIC
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,250.77 |
| Max. Negotiated Rate |
$2,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,224.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,498.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,179.20
|
| Rate for Payer: Altius Commercial |
$2,179.20
|
| Rate for Payer: Beech Street Commercial |
$2,224.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,863.67
|
| Rate for Payer: Cash Price |
$1,589.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,201.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,224.60
|
| Rate for Payer: Entrust Commercial |
$2,156.50
|
| Rate for Payer: First Choice Health Commercial |
$2,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,316.60
|
| Rate for Payer: HealthUtah PPO |
$2,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,201.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,250.77
|
| Rate for Payer: One Health Plan of WY PPO |
$2,224.60
|
| Rate for Payer: PacificSource Commercial |
$2,043.00
|
| Rate for Payer: PHCS PPO |
$2,224.60
|
| Rate for Payer: Three Rivers PPO |
$1,702.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,316.60
|
| Rate for Payer: United Healthcare Commercial |
$1,974.90
|
| Rate for Payer: United Healthcare Medicare |
$1,316.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,224.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,156.50
|
|
|
HC K FLOW/FUNCT IMAGE W/DRUG - NM KIDNEY FLOW/FUNCTION WITH DIURETIC
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,423.29 |
| Max. Negotiated Rate |
$2,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,224.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,179.20
|
| Rate for Payer: Altius Commercial |
$2,179.20
|
| Rate for Payer: Beech Street Commercial |
$2,224.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,863.67
|
| Rate for Payer: Cash Price |
$1,589.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,201.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,224.60
|
| Rate for Payer: Entrust Commercial |
$2,156.50
|
| Rate for Payer: First Choice Health Commercial |
$2,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,156.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,498.20
|
| Rate for Payer: HealthUtah PPO |
$2,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,201.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,423.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,224.60
|
| Rate for Payer: PacificSource Commercial |
$2,043.00
|
| Rate for Payer: PHCS PPO |
$2,224.60
|
| Rate for Payer: Three Rivers PPO |
$1,702.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,498.20
|
| Rate for Payer: United Healthcare Commercial |
$1,974.90
|
| Rate for Payer: United Healthcare Medicare |
$1,498.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,156.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,156.50
|
|
|
HC KIT DRAW FROM EMPLOYEE
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3000000019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| 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 Auto/Workers Compensation |
$28.80
|
| 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 |
$24.63
|
| 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 |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| 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 |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC KIT DRAW FROM EMPLOYEE
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3000000019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| 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 |
$24.63
|
| 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 |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| 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 |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC KIT DRAW FROM PATIENT
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3000000021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC KIT DRAW FROM PATIENT
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3000000021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
