HC TELEHEALTH ORIGIN SITE FAC FEE
|
Facility
|
OP
|
$70.00
|
|
Service Code
|
HCPCS Q3014
|
Hospital Charge Code |
780Q301401
|
Hospital Revenue Code
|
780
|
Min. Negotiated Rate |
$38.57 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
Rate for Payer: Aetna of WY Medicare |
$46.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
Rate for Payer: Altius Commercial |
$67.20
|
Rate for Payer: Beech Street Commercial |
$68.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
Rate for Payer: Cash Price |
$49.00
|
Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
Rate for Payer: Cigna of WY Commercial |
$68.60
|
Rate for Payer: Entrust Commercial |
$66.50
|
Rate for Payer: First Choice Health Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
Rate for Payer: HealthUtah PPO |
$70.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
Rate for Payer: Multiplan Medicare/VA |
$38.57
|
Rate for Payer: One Health Plan of WY PPO |
$68.60
|
Rate for Payer: PacificSource Commercial |
$63.00
|
Rate for Payer: PHCS PPO |
$68.60
|
Rate for Payer: Three Rivers PPO |
$52.50
|
Rate for Payer: TriWest Veterans Administration |
$40.60
|
Rate for Payer: United Healthcare Commercial |
$60.90
|
Rate for Payer: United Healthcare Medicare |
$40.60
|
Rate for Payer: WINHealth Partners Commercial |
$68.60
|
Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
HC TELEHEALTH ORIGIN SITE FAC FEE
|
Facility
|
IP
|
$70.00
|
|
Service Code
|
HCPCS Q3014
|
Hospital Charge Code |
780Q301401
|
Hospital Revenue Code
|
780
|
Min. Negotiated Rate |
$43.89 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
Rate for Payer: Altius Commercial |
$67.20
|
Rate for Payer: Beech Street Commercial |
$68.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
Rate for Payer: Cash Price |
$49.00
|
Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
Rate for Payer: Cigna of WY Commercial |
$68.60
|
Rate for Payer: Entrust Commercial |
$66.50
|
Rate for Payer: First Choice Health Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
Rate for Payer: HealthUtah PPO |
$70.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
Rate for Payer: Multiplan Medicare/VA |
$43.89
|
Rate for Payer: One Health Plan of WY PPO |
$68.60
|
Rate for Payer: PacificSource Commercial |
$63.00
|
Rate for Payer: PHCS PPO |
$68.60
|
Rate for Payer: Three Rivers PPO |
$52.50
|
Rate for Payer: TriWest Veterans Administration |
$46.20
|
Rate for Payer: United Healthcare Commercial |
$60.90
|
Rate for Payer: United Healthcare Medicare |
$46.20
|
Rate for Payer: WINHealth Partners Commercial |
$66.50
|
Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
HC TENS UNIT
|
Facility
|
IP
|
$100.00
|
|
Service Code
|
HCPCS A4595
|
Hospital Charge Code |
420A459501
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$62.70 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
Rate for Payer: Altius Commercial |
$96.00
|
Rate for Payer: Beech Street Commercial |
$98.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
Rate for Payer: Cash Price |
$70.00
|
Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
Rate for Payer: Cigna of WY Commercial |
$98.00
|
Rate for Payer: Entrust Commercial |
$95.00
|
Rate for Payer: First Choice Health Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
Rate for Payer: HealthUtah PPO |
$100.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
Rate for Payer: Multiplan Medicare/VA |
$62.70
|
Rate for Payer: One Health Plan of WY PPO |
$98.00
|
Rate for Payer: PacificSource Commercial |
$90.00
|
Rate for Payer: PHCS PPO |
$98.00
|
Rate for Payer: Three Rivers PPO |
$75.00
|
Rate for Payer: TriWest Veterans Administration |
$66.00
|
Rate for Payer: United Healthcare Commercial |
$87.00
|
Rate for Payer: United Healthcare Medicare |
$66.00
|
Rate for Payer: WINHealth Partners Commercial |
$95.00
|
Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
HC TENS UNIT
|
Facility
|
OP
|
$100.00
|
|
Service Code
|
HCPCS A4595
|
Hospital Charge Code |
420A459501
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$55.10 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
Rate for Payer: Aetna of WY Medicare |
$66.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
Rate for Payer: Altius Commercial |
$96.00
|
Rate for Payer: Beech Street Commercial |
$98.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
Rate for Payer: Cash Price |
$70.00
|
Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
Rate for Payer: Cigna of WY Commercial |
$98.00
|
Rate for Payer: Entrust Commercial |
$95.00
|
Rate for Payer: First Choice Health Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
Rate for Payer: HealthUtah PPO |
$100.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
Rate for Payer: Multiplan Medicare/VA |
$55.10
|
Rate for Payer: One Health Plan of WY PPO |
$98.00
|
Rate for Payer: PacificSource Commercial |
$90.00
|
Rate for Payer: PHCS PPO |
$98.00
|
Rate for Payer: Three Rivers PPO |
$75.00
|
Rate for Payer: TriWest Veterans Administration |
$58.00
|
Rate for Payer: United Healthcare Commercial |
$87.00
|
Rate for Payer: United Healthcare Medicare |
$58.00
|
Rate for Payer: WINHealth Partners Commercial |
$98.00
|
Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
HC TENS UNIT
|
Facility
|
OP
|
$100.00
|
|
Service Code
|
HCPCS A4595
|
Hospital Charge Code |
430A459501
|
Hospital Revenue Code
|
430
|
Min. Negotiated Rate |
$55.10 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
Rate for Payer: Aetna of WY Medicare |
$66.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
Rate for Payer: Altius Commercial |
$96.00
|
Rate for Payer: Beech Street Commercial |
$98.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
Rate for Payer: Cash Price |
$70.00
|
Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
Rate for Payer: Cigna of WY Commercial |
$98.00
|
Rate for Payer: Entrust Commercial |
$95.00
|
Rate for Payer: First Choice Health Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
Rate for Payer: HealthUtah PPO |
$100.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
Rate for Payer: Multiplan Medicare/VA |
$55.10
|
Rate for Payer: One Health Plan of WY PPO |
$98.00
|
Rate for Payer: PacificSource Commercial |
$90.00
|
Rate for Payer: PHCS PPO |
$98.00
|
Rate for Payer: Three Rivers PPO |
$75.00
|
Rate for Payer: TriWest Veterans Administration |
$58.00
|
Rate for Payer: United Healthcare Commercial |
$87.00
|
Rate for Payer: United Healthcare Medicare |
$58.00
|
Rate for Payer: WINHealth Partners Commercial |
$98.00
|
Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
HC TENS UNIT
|
Facility
|
IP
|
$100.00
|
|
Service Code
|
HCPCS A4595
|
Hospital Charge Code |
430A459501
|
Hospital Revenue Code
|
430
|
Min. Negotiated Rate |
$62.70 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
Rate for Payer: Altius Commercial |
$96.00
|
Rate for Payer: Beech Street Commercial |
$98.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
Rate for Payer: Cash Price |
$70.00
|
Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
Rate for Payer: Cigna of WY Commercial |
$98.00
|
Rate for Payer: Entrust Commercial |
$95.00
|
Rate for Payer: First Choice Health Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
Rate for Payer: HealthUtah PPO |
$100.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
Rate for Payer: Multiplan Medicare/VA |
$62.70
|
Rate for Payer: One Health Plan of WY PPO |
$98.00
|
Rate for Payer: PacificSource Commercial |
$90.00
|
Rate for Payer: PHCS PPO |
$98.00
|
Rate for Payer: Three Rivers PPO |
$75.00
|
Rate for Payer: TriWest Veterans Administration |
$66.00
|
Rate for Payer: United Healthcare Commercial |
$87.00
|
Rate for Payer: United Healthcare Medicare |
$66.00
|
Rate for Payer: WINHealth Partners Commercial |
$95.00
|
Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
HC TETANUS - TETANUS TOXOID, IGG
|
Facility
|
IP
|
$130.00
|
|
Service Code
|
HCPCS 86774
|
Hospital Charge Code |
3028677401
|
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 TETANUS - TETANUS TOXOID, IGG
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS 86774
|
Hospital Charge Code |
3028677401
|
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 THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG
|
Facility
|
IP
|
$355.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
5109637501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$222.58 |
Max. Negotiated Rate |
$355.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
Rate for Payer: Altius Commercial |
$340.80
|
Rate for Payer: Beech Street Commercial |
$347.90
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
Rate for Payer: Cash Price |
$248.50
|
Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
Rate for Payer: Cigna of WY Commercial |
$347.90
|
Rate for Payer: Entrust Commercial |
$337.25
|
Rate for Payer: First Choice Health Commercial |
$337.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
Rate for Payer: HealthUtah PPO |
$355.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
Rate for Payer: Multiplan Medicare/VA |
$222.58
|
Rate for Payer: One Health Plan of WY PPO |
$347.90
|
Rate for Payer: PacificSource Commercial |
$319.50
|
Rate for Payer: PHCS PPO |
$347.90
|
Rate for Payer: Three Rivers PPO |
$266.25
|
Rate for Payer: TriWest Veterans Administration |
$234.30
|
Rate for Payer: United Healthcare Commercial |
$308.85
|
Rate for Payer: United Healthcare Medicare |
$234.30
|
Rate for Payer: WINHealth Partners Commercial |
$337.25
|
Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
HC THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG
|
Facility
|
OP
|
$355.00
|
|
Service Code
|
HCPCS 96375
|
Hospital Charge Code |
5109637501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$195.60 |
Max. Negotiated Rate |
$355.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
Rate for Payer: Aetna of WY Medicare |
$234.30
|
Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
Rate for Payer: Altius Commercial |
$340.80
|
Rate for Payer: Beech Street Commercial |
$347.90
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
Rate for Payer: Cash Price |
$248.50
|
Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
Rate for Payer: Cigna of WY Commercial |
$347.90
|
Rate for Payer: Entrust Commercial |
$337.25
|
Rate for Payer: First Choice Health Commercial |
$337.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
Rate for Payer: HealthUtah PPO |
$355.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
Rate for Payer: Multiplan Medicare/VA |
$195.60
|
Rate for Payer: One Health Plan of WY PPO |
$347.90
|
Rate for Payer: PacificSource Commercial |
$319.50
|
Rate for Payer: PHCS PPO |
$347.90
|
Rate for Payer: Three Rivers PPO |
$266.25
|
Rate for Payer: TriWest Veterans Administration |
$205.90
|
Rate for Payer: United Healthcare Commercial |
$308.85
|
Rate for Payer: United Healthcare Medicare |
$205.90
|
Rate for Payer: WINHealth Partners Commercial |
$347.90
|
Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
HC THIOPURINE S-METHYLTRANSFERASE (TPMT)
|
Facility
|
OP
|
$22.00
|
|
Service Code
|
HCPCS 84433
|
Hospital Charge Code |
3018443301
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$12.12 |
Max. Negotiated Rate |
$22.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
Rate for Payer: Aetna of WY Medicare |
$14.52
|
Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
Rate for Payer: Altius Commercial |
$21.12
|
Rate for Payer: Beech Street Commercial |
$21.56
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
Rate for Payer: Cash Price |
$15.40
|
Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
Rate for Payer: Cigna of WY Commercial |
$21.56
|
Rate for Payer: Entrust Commercial |
$20.90
|
Rate for Payer: First Choice Health Commercial |
$20.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.76
|
Rate for Payer: HealthUtah PPO |
$22.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
Rate for Payer: Multiplan Medicare/VA |
$12.12
|
Rate for Payer: One Health Plan of WY PPO |
$21.56
|
Rate for Payer: PacificSource Commercial |
$19.80
|
Rate for Payer: PHCS PPO |
$21.56
|
Rate for Payer: Three Rivers PPO |
$16.50
|
Rate for Payer: TriWest Veterans Administration |
$12.76
|
Rate for Payer: United Healthcare Commercial |
$19.14
|
Rate for Payer: United Healthcare Medicare |
$12.76
|
Rate for Payer: WINHealth Partners Commercial |
$21.56
|
Rate for Payer: Wise Provider Network Commercial |
$20.90
|
|
HC THIOPURINE S-METHYLTRANSFERASE (TPMT)
|
Facility
|
IP
|
$22.00
|
|
Service Code
|
HCPCS 84433
|
Hospital Charge Code |
3018443301
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$13.79 |
Max. Negotiated Rate |
$22.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
Rate for Payer: Altius Commercial |
$21.12
|
Rate for Payer: Beech Street Commercial |
$21.56
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
Rate for Payer: Cash Price |
$15.40
|
Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
Rate for Payer: Cigna of WY Commercial |
$21.56
|
Rate for Payer: Entrust Commercial |
$20.90
|
Rate for Payer: First Choice Health Commercial |
$20.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
Rate for Payer: HealthUtah PPO |
$22.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
Rate for Payer: Multiplan Medicare/VA |
$13.79
|
Rate for Payer: One Health Plan of WY PPO |
$21.56
|
Rate for Payer: PacificSource Commercial |
$19.80
|
Rate for Payer: PHCS PPO |
$21.56
|
Rate for Payer: Three Rivers PPO |
$16.50
|
Rate for Payer: TriWest Veterans Administration |
$14.52
|
Rate for Payer: United Healthcare Commercial |
$19.14
|
Rate for Payer: United Healthcare Medicare |
$14.52
|
Rate for Payer: WINHealth Partners Commercial |
$20.90
|
Rate for Payer: Wise Provider Network Commercial |
$20.90
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$5,120.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
4023255501
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$2,821.12 |
Max. Negotiated Rate |
$5,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,017.60
|
Rate for Payer: Aetna of WY Medicare |
$3,379.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$4,915.20
|
Rate for Payer: Altius Commercial |
$4,915.20
|
Rate for Payer: Beech Street Commercial |
$5,017.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,203.52
|
Rate for Payer: Cash Price |
$3,584.00
|
Rate for Payer: ChoiceCare Network Commercial |
$4,966.40
|
Rate for Payer: Cigna of WY Commercial |
$5,017.60
|
Rate for Payer: Entrust Commercial |
$4,864.00
|
Rate for Payer: First Choice Health Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,969.60
|
Rate for Payer: HealthUtah PPO |
$5,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,966.40
|
Rate for Payer: Multiplan Medicare/VA |
$2,821.12
|
Rate for Payer: One Health Plan of WY PPO |
$5,017.60
|
Rate for Payer: PacificSource Commercial |
$4,608.00
|
Rate for Payer: PHCS PPO |
$5,017.60
|
Rate for Payer: Three Rivers PPO |
$3,840.00
|
Rate for Payer: TriWest Veterans Administration |
$2,969.60
|
Rate for Payer: United Healthcare Commercial |
$4,454.40
|
Rate for Payer: United Healthcare Medicare |
$2,969.60
|
Rate for Payer: WINHealth Partners Commercial |
$5,017.60
|
Rate for Payer: Wise Provider Network Commercial |
$4,864.00
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$5,120.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
4023255501
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$3,210.24 |
Max. Negotiated Rate |
$5,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,017.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$4,915.20
|
Rate for Payer: Altius Commercial |
$4,915.20
|
Rate for Payer: Beech Street Commercial |
$5,017.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,203.52
|
Rate for Payer: Cash Price |
$3,584.00
|
Rate for Payer: ChoiceCare Network Commercial |
$4,966.40
|
Rate for Payer: Cigna of WY Commercial |
$5,017.60
|
Rate for Payer: Entrust Commercial |
$4,864.00
|
Rate for Payer: First Choice Health Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,379.20
|
Rate for Payer: HealthUtah PPO |
$5,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,966.40
|
Rate for Payer: Multiplan Medicare/VA |
$3,210.24
|
Rate for Payer: One Health Plan of WY PPO |
$5,017.60
|
Rate for Payer: PacificSource Commercial |
$4,608.00
|
Rate for Payer: PHCS PPO |
$5,017.60
|
Rate for Payer: Three Rivers PPO |
$3,840.00
|
Rate for Payer: TriWest Veterans Administration |
$3,379.20
|
Rate for Payer: United Healthcare Commercial |
$4,454.40
|
Rate for Payer: United Healthcare Medicare |
$3,379.20
|
Rate for Payer: WINHealth Partners Commercial |
$4,864.00
|
Rate for Payer: Wise Provider Network Commercial |
$4,864.00
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
7613255501
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$294.23 |
Max. Negotiated Rate |
$534.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
Rate for Payer: Aetna of WY Medicare |
$352.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
Rate for Payer: Altius Commercial |
$512.64
|
Rate for Payer: Beech Street Commercial |
$523.32
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
Rate for Payer: Cash Price |
$373.80
|
Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
Rate for Payer: Cigna of WY Commercial |
$523.32
|
Rate for Payer: Entrust Commercial |
$507.30
|
Rate for Payer: First Choice Health Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
Rate for Payer: HealthUtah PPO |
$534.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
Rate for Payer: Multiplan Medicare/VA |
$294.23
|
Rate for Payer: One Health Plan of WY PPO |
$523.32
|
Rate for Payer: PacificSource Commercial |
$480.60
|
Rate for Payer: PHCS PPO |
$523.32
|
Rate for Payer: Three Rivers PPO |
$400.50
|
Rate for Payer: TriWest Veterans Administration |
$309.72
|
Rate for Payer: United Healthcare Commercial |
$464.58
|
Rate for Payer: United Healthcare Medicare |
$309.72
|
Rate for Payer: WINHealth Partners Commercial |
$523.32
|
Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$5,120.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
3503255501
|
Hospital Revenue Code
|
350
|
Min. Negotiated Rate |
$2,821.12 |
Max. Negotiated Rate |
$5,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,017.60
|
Rate for Payer: Aetna of WY Medicare |
$3,379.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$4,915.20
|
Rate for Payer: Altius Commercial |
$4,915.20
|
Rate for Payer: Beech Street Commercial |
$5,017.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,203.52
|
Rate for Payer: Cash Price |
$3,584.00
|
Rate for Payer: ChoiceCare Network Commercial |
$4,966.40
|
Rate for Payer: Cigna of WY Commercial |
$5,017.60
|
Rate for Payer: Entrust Commercial |
$4,864.00
|
Rate for Payer: First Choice Health Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,969.60
|
Rate for Payer: HealthUtah PPO |
$5,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,966.40
|
Rate for Payer: Multiplan Medicare/VA |
$2,821.12
|
Rate for Payer: One Health Plan of WY PPO |
$5,017.60
|
Rate for Payer: PacificSource Commercial |
$4,608.00
|
Rate for Payer: PHCS PPO |
$5,017.60
|
Rate for Payer: Three Rivers PPO |
$3,840.00
|
Rate for Payer: TriWest Veterans Administration |
$2,969.60
|
Rate for Payer: United Healthcare Commercial |
$4,454.40
|
Rate for Payer: United Healthcare Medicare |
$2,969.60
|
Rate for Payer: WINHealth Partners Commercial |
$5,017.60
|
Rate for Payer: Wise Provider Network Commercial |
$4,864.00
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$5,120.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
3503255501
|
Hospital Revenue Code
|
350
|
Min. Negotiated Rate |
$3,210.24 |
Max. Negotiated Rate |
$5,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,017.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$4,915.20
|
Rate for Payer: Altius Commercial |
$4,915.20
|
Rate for Payer: Beech Street Commercial |
$5,017.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,203.52
|
Rate for Payer: Cash Price |
$3,584.00
|
Rate for Payer: ChoiceCare Network Commercial |
$4,966.40
|
Rate for Payer: Cigna of WY Commercial |
$5,017.60
|
Rate for Payer: Entrust Commercial |
$4,864.00
|
Rate for Payer: First Choice Health Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,864.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,379.20
|
Rate for Payer: HealthUtah PPO |
$5,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,966.40
|
Rate for Payer: Multiplan Medicare/VA |
$3,210.24
|
Rate for Payer: One Health Plan of WY PPO |
$5,017.60
|
Rate for Payer: PacificSource Commercial |
$4,608.00
|
Rate for Payer: PHCS PPO |
$5,017.60
|
Rate for Payer: Three Rivers PPO |
$3,840.00
|
Rate for Payer: TriWest Veterans Administration |
$3,379.20
|
Rate for Payer: United Healthcare Commercial |
$4,454.40
|
Rate for Payer: United Healthcare Medicare |
$3,379.20
|
Rate for Payer: WINHealth Partners Commercial |
$4,864.00
|
Rate for Payer: Wise Provider Network Commercial |
$4,864.00
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 32555
|
Hospital Charge Code |
7613255501
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$334.82 |
Max. Negotiated Rate |
$534.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
Rate for Payer: Altius Commercial |
$512.64
|
Rate for Payer: Beech Street Commercial |
$523.32
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
Rate for Payer: Cash Price |
$373.80
|
Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
Rate for Payer: Cigna of WY Commercial |
$523.32
|
Rate for Payer: Entrust Commercial |
$507.30
|
Rate for Payer: First Choice Health Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
Rate for Payer: HealthUtah PPO |
$534.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
Rate for Payer: Multiplan Medicare/VA |
$334.82
|
Rate for Payer: One Health Plan of WY PPO |
$523.32
|
Rate for Payer: PacificSource Commercial |
$480.60
|
Rate for Payer: PHCS PPO |
$523.32
|
Rate for Payer: Three Rivers PPO |
$400.50
|
Rate for Payer: TriWest Veterans Administration |
$352.44
|
Rate for Payer: United Healthcare Commercial |
$464.58
|
Rate for Payer: United Healthcare Medicare |
$352.44
|
Rate for Payer: WINHealth Partners Commercial |
$507.30
|
Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 32554
|
Hospital Charge Code |
7613255401
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$294.23 |
Max. Negotiated Rate |
$534.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
Rate for Payer: Aetna of WY Medicare |
$352.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
Rate for Payer: Altius Commercial |
$512.64
|
Rate for Payer: Beech Street Commercial |
$523.32
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
Rate for Payer: Cash Price |
$373.80
|
Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
Rate for Payer: Cigna of WY Commercial |
$523.32
|
Rate for Payer: Entrust Commercial |
$507.30
|
Rate for Payer: First Choice Health Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
Rate for Payer: HealthUtah PPO |
$534.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
Rate for Payer: Multiplan Medicare/VA |
$294.23
|
Rate for Payer: One Health Plan of WY PPO |
$523.32
|
Rate for Payer: PacificSource Commercial |
$480.60
|
Rate for Payer: PHCS PPO |
$523.32
|
Rate for Payer: Three Rivers PPO |
$400.50
|
Rate for Payer: TriWest Veterans Administration |
$309.72
|
Rate for Payer: United Healthcare Commercial |
$464.58
|
Rate for Payer: United Healthcare Medicare |
$309.72
|
Rate for Payer: WINHealth Partners Commercial |
$523.32
|
Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 32554
|
Hospital Charge Code |
7613255401
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$334.82 |
Max. Negotiated Rate |
$534.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
Rate for Payer: Altius Commercial |
$512.64
|
Rate for Payer: Beech Street Commercial |
$523.32
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
Rate for Payer: Cash Price |
$373.80
|
Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
Rate for Payer: Cigna of WY Commercial |
$523.32
|
Rate for Payer: Entrust Commercial |
$507.30
|
Rate for Payer: First Choice Health Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
Rate for Payer: HealthUtah PPO |
$534.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
Rate for Payer: Multiplan Medicare/VA |
$334.82
|
Rate for Payer: One Health Plan of WY PPO |
$523.32
|
Rate for Payer: PacificSource Commercial |
$480.60
|
Rate for Payer: PHCS PPO |
$523.32
|
Rate for Payer: Three Rivers PPO |
$400.50
|
Rate for Payer: TriWest Veterans Administration |
$352.44
|
Rate for Payer: United Healthcare Commercial |
$464.58
|
Rate for Payer: United Healthcare Medicare |
$352.44
|
Rate for Payer: WINHealth Partners Commercial |
$507.30
|
Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
IP
|
$186.00
|
|
Service Code
|
HCPCS 32554 50
|
Hospital Charge Code |
5103255401
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$116.62 |
Max. Negotiated Rate |
$186.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.28
|
Rate for Payer: Altius Auto/Workers Compensation |
$178.56
|
Rate for Payer: Altius Commercial |
$178.56
|
Rate for Payer: Beech Street Commercial |
$182.28
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.71
|
Rate for Payer: Cash Price |
$130.20
|
Rate for Payer: ChoiceCare Network Commercial |
$180.42
|
Rate for Payer: Cigna of WY Commercial |
$182.28
|
Rate for Payer: Entrust Commercial |
$176.70
|
Rate for Payer: First Choice Health Commercial |
$176.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.76
|
Rate for Payer: HealthUtah PPO |
$186.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.42
|
Rate for Payer: Multiplan Medicare/VA |
$116.62
|
Rate for Payer: One Health Plan of WY PPO |
$182.28
|
Rate for Payer: PacificSource Commercial |
$167.40
|
Rate for Payer: PHCS PPO |
$182.28
|
Rate for Payer: Three Rivers PPO |
$139.50
|
Rate for Payer: TriWest Veterans Administration |
$122.76
|
Rate for Payer: United Healthcare Commercial |
$161.82
|
Rate for Payer: United Healthcare Medicare |
$122.76
|
Rate for Payer: WINHealth Partners Commercial |
$176.70
|
Rate for Payer: Wise Provider Network Commercial |
$176.70
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
OP
|
$186.00
|
|
Service Code
|
HCPCS 32554 50
|
Hospital Charge Code |
5103255401
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$102.49 |
Max. Negotiated Rate |
$186.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$182.28
|
Rate for Payer: Aetna of WY Medicare |
$122.76
|
Rate for Payer: Altius Auto/Workers Compensation |
$178.56
|
Rate for Payer: Altius Commercial |
$178.56
|
Rate for Payer: Beech Street Commercial |
$182.28
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.71
|
Rate for Payer: Cash Price |
$130.20
|
Rate for Payer: ChoiceCare Network Commercial |
$180.42
|
Rate for Payer: Cigna of WY Commercial |
$182.28
|
Rate for Payer: Entrust Commercial |
$176.70
|
Rate for Payer: First Choice Health Commercial |
$176.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$176.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.88
|
Rate for Payer: HealthUtah PPO |
$186.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$180.42
|
Rate for Payer: Multiplan Medicare/VA |
$102.49
|
Rate for Payer: One Health Plan of WY PPO |
$182.28
|
Rate for Payer: PacificSource Commercial |
$167.40
|
Rate for Payer: PHCS PPO |
$182.28
|
Rate for Payer: Three Rivers PPO |
$139.50
|
Rate for Payer: TriWest Veterans Administration |
$107.88
|
Rate for Payer: United Healthcare Commercial |
$161.82
|
Rate for Payer: United Healthcare Medicare |
$107.88
|
Rate for Payer: WINHealth Partners Commercial |
$182.28
|
Rate for Payer: Wise Provider Network Commercial |
$176.70
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
OP
|
$93.00
|
|
Service Code
|
HCPCS 32554
|
Hospital Charge Code |
5103255401
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$51.24 |
Max. Negotiated Rate |
$93.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
Rate for Payer: Aetna of WY Medicare |
$61.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
Rate for Payer: Altius Commercial |
$89.28
|
Rate for Payer: Beech Street Commercial |
$91.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
Rate for Payer: Cash Price |
$65.10
|
Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
Rate for Payer: Cigna of WY Commercial |
$91.14
|
Rate for Payer: Entrust Commercial |
$88.35
|
Rate for Payer: First Choice Health Commercial |
$88.35
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.94
|
Rate for Payer: HealthUtah PPO |
$93.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
Rate for Payer: Multiplan Medicare/VA |
$51.24
|
Rate for Payer: One Health Plan of WY PPO |
$91.14
|
Rate for Payer: PacificSource Commercial |
$83.70
|
Rate for Payer: PHCS PPO |
$91.14
|
Rate for Payer: Three Rivers PPO |
$69.75
|
Rate for Payer: TriWest Veterans Administration |
$53.94
|
Rate for Payer: United Healthcare Commercial |
$80.91
|
Rate for Payer: United Healthcare Medicare |
$53.94
|
Rate for Payer: WINHealth Partners Commercial |
$91.14
|
Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Facility
|
IP
|
$93.00
|
|
Service Code
|
HCPCS 32554
|
Hospital Charge Code |
5103255401
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$58.31 |
Max. Negotiated Rate |
$93.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
Rate for Payer: Altius Commercial |
$89.28
|
Rate for Payer: Beech Street Commercial |
$91.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
Rate for Payer: Cash Price |
$65.10
|
Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
Rate for Payer: Cigna of WY Commercial |
$91.14
|
Rate for Payer: Entrust Commercial |
$88.35
|
Rate for Payer: First Choice Health Commercial |
$88.35
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.38
|
Rate for Payer: HealthUtah PPO |
$93.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
Rate for Payer: Multiplan Medicare/VA |
$58.31
|
Rate for Payer: One Health Plan of WY PPO |
$91.14
|
Rate for Payer: PacificSource Commercial |
$83.70
|
Rate for Payer: PHCS PPO |
$91.14
|
Rate for Payer: Three Rivers PPO |
$69.75
|
Rate for Payer: TriWest Veterans Administration |
$61.38
|
Rate for Payer: United Healthcare Commercial |
$80.91
|
Rate for Payer: United Healthcare Medicare |
$61.38
|
Rate for Payer: WINHealth Partners Commercial |
$88.35
|
Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
HC THROMBOPLAS TIME PARTIAL (APTT) - PLASMA/WHOLE BLOOD
|
Facility
|
IP
|
$180.00
|
|
Service Code
|
HCPCS 85730
|
Hospital Charge Code |
3058573001
|
Hospital Revenue Code
|
305
|
Min. Negotiated Rate |
$112.86 |
Max. Negotiated Rate |
$180.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
Rate for Payer: Altius Commercial |
$172.80
|
Rate for Payer: Beech Street Commercial |
$176.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
Rate for Payer: Cigna of WY Commercial |
$176.40
|
Rate for Payer: Entrust Commercial |
$171.00
|
Rate for Payer: First Choice Health Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
Rate for Payer: HealthUtah PPO |
$180.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
Rate for Payer: Multiplan Medicare/VA |
$112.86
|
Rate for Payer: One Health Plan of WY PPO |
$176.40
|
Rate for Payer: PacificSource Commercial |
$162.00
|
Rate for Payer: PHCS PPO |
$176.40
|
Rate for Payer: Three Rivers PPO |
$135.00
|
Rate for Payer: TriWest Veterans Administration |
$118.80
|
Rate for Payer: United Healthcare Commercial |
$156.60
|
Rate for Payer: United Healthcare Medicare |
$118.80
|
Rate for Payer: WINHealth Partners Commercial |
$171.00
|
Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|