|
HC RT NON-INVASIVE VENT
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
4100000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC RT NON-INVASIVE VENT
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
4100000001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC RT NON-INVASIVE VENT MGMT, SUBSEQ DAY
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400302
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,363.72 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,633.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,376.00
|
| Rate for Payer: Altius Commercial |
$2,376.00
|
| Rate for Payer: Beech Street Commercial |
$2,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.50
|
| Rate for Payer: Entrust Commercial |
$2,351.25
|
| Rate for Payer: First Choice Health Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,435.50
|
| Rate for Payer: HealthUtah PPO |
$2,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,363.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.50
|
| Rate for Payer: PacificSource Commercial |
$2,227.50
|
| Rate for Payer: PHCS PPO |
$2,425.50
|
| Rate for Payer: Three Rivers PPO |
$1,856.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,435.50
|
| Rate for Payer: United Healthcare Commercial |
$2,153.25
|
| Rate for Payer: United Healthcare Medicare |
$1,435.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,425.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,351.25
|
|
|
HC RT NON-INVASIVE VENT MGMT, SUBSEQ DAY
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400302
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,551.82 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,376.00
|
| Rate for Payer: Altius Commercial |
$2,376.00
|
| Rate for Payer: Beech Street Commercial |
$2,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.50
|
| Rate for Payer: Entrust Commercial |
$2,351.25
|
| Rate for Payer: First Choice Health Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,633.50
|
| Rate for Payer: HealthUtah PPO |
$2,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,551.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.50
|
| Rate for Payer: PacificSource Commercial |
$2,227.50
|
| Rate for Payer: PHCS PPO |
$2,425.50
|
| Rate for Payer: Three Rivers PPO |
$1,856.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$2,153.25
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,351.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,351.25
|
|
|
HC RT NONINVASV OXYGEN SATUR,MULTIPLE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4109476101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC RT NONINVASV OXYGEN SATUR,MULTIPLE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4109476101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC RT NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4109476201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC RT NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4109476201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC RT SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9429896001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RT SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
9429896001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RT VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$873.34 |
| Max. Negotiated Rate |
$1,585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,553.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,046.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,521.60
|
| Rate for Payer: Altius Commercial |
$1,521.60
|
| Rate for Payer: Beech Street Commercial |
$1,553.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,301.28
|
| Rate for Payer: Cash Price |
$1,109.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,537.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,553.30
|
| Rate for Payer: Entrust Commercial |
$1,505.75
|
| Rate for Payer: First Choice Health Commercial |
$1,505.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,505.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$919.30
|
| Rate for Payer: HealthUtah PPO |
$1,585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,537.45
|
| Rate for Payer: Multiplan Medicare/VA |
$873.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,553.30
|
| Rate for Payer: PacificSource Commercial |
$1,426.50
|
| Rate for Payer: PHCS PPO |
$1,553.30
|
| Rate for Payer: Three Rivers PPO |
$1,188.75
|
| Rate for Payer: TriWest Veterans Administration |
$919.30
|
| Rate for Payer: United Healthcare Commercial |
$1,378.95
|
| Rate for Payer: United Healthcare Medicare |
$919.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,553.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,505.75
|
|
|
HC RT VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$993.80 |
| Max. Negotiated Rate |
$1,585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,553.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,521.60
|
| Rate for Payer: Altius Commercial |
$1,521.60
|
| Rate for Payer: Beech Street Commercial |
$1,553.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,301.28
|
| Rate for Payer: Cash Price |
$1,109.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,537.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,553.30
|
| Rate for Payer: Entrust Commercial |
$1,505.75
|
| Rate for Payer: First Choice Health Commercial |
$1,505.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,505.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,046.10
|
| Rate for Payer: HealthUtah PPO |
$1,585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,537.45
|
| Rate for Payer: Multiplan Medicare/VA |
$993.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,553.30
|
| Rate for Payer: PacificSource Commercial |
$1,426.50
|
| Rate for Payer: PHCS PPO |
$1,553.30
|
| Rate for Payer: Three Rivers PPO |
$1,188.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,046.10
|
| Rate for Payer: United Healthcare Commercial |
$1,378.95
|
| Rate for Payer: United Healthcare Medicare |
$1,046.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,505.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,505.75
|
|
|
HC RT VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,363.72 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,633.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,376.00
|
| Rate for Payer: Altius Commercial |
$2,376.00
|
| Rate for Payer: Beech Street Commercial |
$2,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.50
|
| Rate for Payer: Entrust Commercial |
$2,351.25
|
| Rate for Payer: First Choice Health Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,435.50
|
| Rate for Payer: HealthUtah PPO |
$2,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,363.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.50
|
| Rate for Payer: PacificSource Commercial |
$2,227.50
|
| Rate for Payer: PHCS PPO |
$2,425.50
|
| Rate for Payer: Three Rivers PPO |
$1,856.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,435.50
|
| Rate for Payer: United Healthcare Commercial |
$2,153.25
|
| Rate for Payer: United Healthcare Medicare |
$1,435.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,425.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,351.25
|
|
|
HC RT VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,551.82 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,425.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,376.00
|
| Rate for Payer: Altius Commercial |
$2,376.00
|
| Rate for Payer: Beech Street Commercial |
$2,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,400.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,425.50
|
| Rate for Payer: Entrust Commercial |
$2,351.25
|
| Rate for Payer: First Choice Health Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,351.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,633.50
|
| Rate for Payer: HealthUtah PPO |
$2,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,400.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,551.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,425.50
|
| Rate for Payer: PacificSource Commercial |
$2,227.50
|
| Rate for Payer: PHCS PPO |
$2,425.50
|
| Rate for Payer: Three Rivers PPO |
$1,856.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,633.50
|
| Rate for Payer: United Healthcare Commercial |
$2,153.25
|
| Rate for Payer: United Healthcare Medicare |
$1,633.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,351.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,351.25
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGG
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGG
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGG/IGM
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGG/IGM
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
3058561301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
