|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW BILAT
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.20 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$398.40
|
| Rate for Payer: Altius Commercial |
$398.40
|
| Rate for Payer: Beech Street Commercial |
$406.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$340.72
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: Entrust Commercial |
$394.25
|
| Rate for Payer: First Choice Health Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$273.90
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Multiplan Medicare/VA |
$260.20
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$406.70
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: TriWest Veterans Administration |
$273.90
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$273.90
|
| Rate for Payer: WINHealth Partners Commercial |
$394.25
|
| Rate for Payer: Wise Provider Network Commercial |
$394.25
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW BILAT
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.66 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Aetna of WY Medicare |
$273.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$398.40
|
| Rate for Payer: Altius Commercial |
$398.40
|
| Rate for Payer: Beech Street Commercial |
$406.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$340.72
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: Entrust Commercial |
$394.25
|
| Rate for Payer: First Choice Health Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.70
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: Multiplan Medicare/VA |
$228.66
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$406.70
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: TriWest Veterans Administration |
$240.70
|
| Rate for Payer: United Healthcare Commercial |
$361.05
|
| Rate for Payer: United Healthcare Medicare |
$240.70
|
| Rate for Payer: WINHealth Partners Commercial |
$406.70
|
| Rate for Payer: Wise Provider Network Commercial |
$394.25
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW LT
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$217.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.40
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW LT
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.80
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$206.91
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$217.80
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$217.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.40
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW RT
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.80
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$206.91
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$217.80
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC RADIOLOGIC SMALL INTESTINE FOLLOW-THRU STDY
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 74248
|
| Hospital Charge Code |
3207424801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Aetna of WY Medicare |
$537.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.70
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$449.06
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$472.70
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$472.70
|
| Rate for Payer: WINHealth Partners Commercial |
$798.70
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
|
HC RADIOLOGIC SMALL INTESTINE FOLLOW-THRU STDY
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 74248
|
| Hospital Charge Code |
3207424801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$537.90
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$511.00
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$537.90
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
| Rate for Payer: WINHealth Partners Commercial |
$774.25
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
|
HC RBC ABSORPTION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
3008697801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.20
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$294.69
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$310.20
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$310.20
|
| Rate for Payer: WINHealth Partners Commercial |
$446.50
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RBC ABSORPTION
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
3008697801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.97 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Aetna of WY Medicare |
$310.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$258.97
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$272.60
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$272.60
|
| Rate for Payer: WINHealth Partners Commercial |
$460.60
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RBC ANITBODY SCREEN
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 86970
|
| Hospital Charge Code |
3008697001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.97 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Aetna of WY Medicare |
$310.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$258.97
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$272.60
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$272.60
|
| Rate for Payer: WINHealth Partners Commercial |
$460.60
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RBC ANITBODY SCREEN
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 86970
|
| Hospital Charge Code |
3008697001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.20
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$294.69
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$310.20
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$310.20
|
| Rate for Payer: WINHealth Partners Commercial |
$446.50
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.14 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$254.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$369.60
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.08
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.30
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$212.14
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$223.30
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$223.30
|
| Rate for Payer: WINHealth Partners Commercial |
$377.30
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.40 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$369.60
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$316.08
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.10
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$241.40
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$254.10
|
| Rate for Payer: WINHealth Partners Commercial |
$365.75
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC RBC LEUKOCYTES REDUCED
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,005.58 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,788.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,204.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,752.00
|
| Rate for Payer: Altius Commercial |
$1,752.00
|
| Rate for Payer: Beech Street Commercial |
$1,788.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,498.32
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,770.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,788.50
|
| Rate for Payer: Entrust Commercial |
$1,733.75
|
| Rate for Payer: First Choice Health Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,058.50
|
| Rate for Payer: HealthUtah PPO |
$1,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,770.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,005.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,788.50
|
| Rate for Payer: PacificSource Commercial |
$1,642.50
|
| Rate for Payer: PHCS PPO |
$1,788.50
|
| Rate for Payer: Three Rivers PPO |
$1,368.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,058.50
|
| Rate for Payer: United Healthcare Commercial |
$1,587.75
|
| Rate for Payer: United Healthcare Medicare |
$1,058.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,788.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,733.75
|
|
|
HC RBC LEUKOCYTES REDUCED
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,144.28 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,788.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,752.00
|
| Rate for Payer: Altius Commercial |
$1,752.00
|
| Rate for Payer: Beech Street Commercial |
$1,788.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,498.32
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,770.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,788.50
|
| Rate for Payer: Entrust Commercial |
$1,733.75
|
| Rate for Payer: First Choice Health Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,204.50
|
| Rate for Payer: HealthUtah PPO |
$1,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,770.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,788.50
|
| Rate for Payer: PacificSource Commercial |
$1,642.50
|
| Rate for Payer: PHCS PPO |
$1,788.50
|
| Rate for Payer: Three Rivers PPO |
$1,368.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,204.50
|
| Rate for Payer: United Healthcare Commercial |
$1,587.75
|
| Rate for Payer: United Healthcare Medicare |
$1,204.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,733.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,733.75
|
|
|
HC RBC LEUKOREDUCED IRRADIATED
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
390P904001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$752.12 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,337.70
|
| Rate for Payer: Aetna of WY Medicare |
$900.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,310.40
|
| Rate for Payer: Altius Commercial |
$1,310.40
|
| Rate for Payer: Beech Street Commercial |
$1,337.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.66
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,324.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,337.70
|
| Rate for Payer: Entrust Commercial |
$1,296.75
|
| Rate for Payer: First Choice Health Commercial |
$1,296.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,296.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$791.70
|
| Rate for Payer: HealthUtah PPO |
$1,365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,324.05
|
| Rate for Payer: Multiplan Medicare/VA |
$752.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,337.70
|
| Rate for Payer: PacificSource Commercial |
$1,228.50
|
| Rate for Payer: PHCS PPO |
$1,337.70
|
| Rate for Payer: Three Rivers PPO |
$1,023.75
|
| Rate for Payer: TriWest Veterans Administration |
$791.70
|
| Rate for Payer: United Healthcare Commercial |
$1,187.55
|
| Rate for Payer: United Healthcare Medicare |
$791.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,337.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,296.75
|
|
|
HC RBC LEUKOREDUCED IRRADIATED
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
390P904001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$855.86 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,337.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,310.40
|
| Rate for Payer: Altius Commercial |
$1,310.40
|
| Rate for Payer: Beech Street Commercial |
$1,337.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,120.66
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,324.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,337.70
|
| Rate for Payer: Entrust Commercial |
$1,296.75
|
| Rate for Payer: First Choice Health Commercial |
$1,296.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,296.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$900.90
|
| Rate for Payer: HealthUtah PPO |
$1,365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,324.05
|
| Rate for Payer: Multiplan Medicare/VA |
$855.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,337.70
|
| Rate for Payer: PacificSource Commercial |
$1,228.50
|
| Rate for Payer: PHCS PPO |
$1,337.70
|
| Rate for Payer: Three Rivers PPO |
$1,023.75
|
| Rate for Payer: TriWest Veterans Administration |
$900.90
|
| Rate for Payer: United Healthcare Commercial |
$1,187.55
|
| Rate for Payer: United Healthcare Medicare |
$900.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,296.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,296.75
|
|
|
HC RBC OSMOTIC FRAGILITY - OSMOTIC FRAGILITY RBC
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 85555
|
| Hospital Charge Code |
3058555502
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC RBC OSMOTIC FRAGILITY - OSMOTIC FRAGILITY RBC
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 85555
|
| Hospital Charge Code |
3058555502
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 85652
|
| Hospital Charge Code |
3058565201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 85652
|
| Hospital Charge Code |
3058565201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
3058566001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
