|
HC UNLISTED MICROBIOLOGY PROCEDURE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
3008799902
|
|
Hospital Revenue Code
|
300
|
| 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 UNLISTED MICROBIOLOGY PROCEDURE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
3008799902
|
|
Hospital Revenue Code
|
300
|
| 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 UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
5102729901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$809.97 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,440.60
|
| Rate for Payer: Aetna of WY Medicare |
$970.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,411.20
|
| Rate for Payer: Altius Commercial |
$1,411.20
|
| Rate for Payer: Beech Street Commercial |
$1,440.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,206.87
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,425.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,440.60
|
| Rate for Payer: Entrust Commercial |
$1,396.50
|
| Rate for Payer: First Choice Health Commercial |
$1,396.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,396.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$852.60
|
| Rate for Payer: HealthUtah PPO |
$1,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,425.90
|
| Rate for Payer: Multiplan Medicare/VA |
$809.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,440.60
|
| Rate for Payer: PacificSource Commercial |
$1,323.00
|
| Rate for Payer: PHCS PPO |
$1,440.60
|
| Rate for Payer: Three Rivers PPO |
$1,102.50
|
| Rate for Payer: TriWest Veterans Administration |
$852.60
|
| Rate for Payer: United Healthcare Commercial |
$1,278.90
|
| Rate for Payer: United Healthcare Medicare |
$852.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,440.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,396.50
|
|
|
HC UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
5102729901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$921.69 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,440.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,411.20
|
| Rate for Payer: Altius Commercial |
$1,411.20
|
| Rate for Payer: Beech Street Commercial |
$1,440.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,206.87
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,425.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,440.60
|
| Rate for Payer: Entrust Commercial |
$1,396.50
|
| Rate for Payer: First Choice Health Commercial |
$1,396.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,396.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$970.20
|
| Rate for Payer: HealthUtah PPO |
$1,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,425.90
|
| Rate for Payer: Multiplan Medicare/VA |
$921.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,440.60
|
| Rate for Payer: PacificSource Commercial |
$1,323.00
|
| Rate for Payer: PHCS PPO |
$1,440.60
|
| Rate for Payer: Three Rivers PPO |
$1,102.50
|
| Rate for Payer: TriWest Veterans Administration |
$970.20
|
| Rate for Payer: United Healthcare Commercial |
$1,278.90
|
| Rate for Payer: United Healthcare Medicare |
$970.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,396.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,396.50
|
|
|
HC UNSPECIFIED MOLECULAR PATH PROCEDURE - CALRETICULIN
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
3108147903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$953.23 |
| Max. Negotiated Rate |
$1,730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,695.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,141.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,660.80
|
| Rate for Payer: Altius Commercial |
$1,660.80
|
| Rate for Payer: Beech Street Commercial |
$1,695.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,420.33
|
| Rate for Payer: Cash Price |
$1,211.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,678.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,695.40
|
| Rate for Payer: Entrust Commercial |
$1,643.50
|
| Rate for Payer: First Choice Health Commercial |
$1,643.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,643.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,003.40
|
| Rate for Payer: HealthUtah PPO |
$1,730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,678.10
|
| Rate for Payer: Multiplan Medicare/VA |
$953.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,695.40
|
| Rate for Payer: PacificSource Commercial |
$1,557.00
|
| Rate for Payer: PHCS PPO |
$1,695.40
|
| Rate for Payer: Three Rivers PPO |
$1,297.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,003.40
|
| Rate for Payer: United Healthcare Commercial |
$1,505.10
|
| Rate for Payer: United Healthcare Medicare |
$1,003.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,695.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,643.50
|
|
|
HC UNSPECIFIED MOLECULAR PATH PROCEDURE - CALRETICULIN
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
3108147903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,084.71 |
| Max. Negotiated Rate |
$1,730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,695.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,660.80
|
| Rate for Payer: Altius Commercial |
$1,660.80
|
| Rate for Payer: Beech Street Commercial |
$1,695.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,420.33
|
| Rate for Payer: Cash Price |
$1,211.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,678.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,695.40
|
| Rate for Payer: Entrust Commercial |
$1,643.50
|
| Rate for Payer: First Choice Health Commercial |
$1,643.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,643.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,141.80
|
| Rate for Payer: HealthUtah PPO |
$1,730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,678.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,084.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,695.40
|
| Rate for Payer: PacificSource Commercial |
$1,557.00
|
| Rate for Payer: PHCS PPO |
$1,695.40
|
| Rate for Payer: Three Rivers PPO |
$1,297.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,141.80
|
| Rate for Payer: United Healthcare Commercial |
$1,505.10
|
| Rate for Payer: United Healthcare Medicare |
$1,141.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,643.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,643.50
|
|
|
HC UNSPECIFIED MOLECULAR PATH PROCEDURE - LCHAD MUTATION
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
3108147902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,031.42 |
| Max. Negotiated Rate |
$1,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,612.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,579.20
|
| Rate for Payer: Altius Commercial |
$1,579.20
|
| Rate for Payer: Beech Street Commercial |
$1,612.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,350.54
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,595.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,612.10
|
| Rate for Payer: Entrust Commercial |
$1,562.75
|
| Rate for Payer: First Choice Health Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,085.70
|
| Rate for Payer: HealthUtah PPO |
$1,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,595.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,031.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,612.10
|
| Rate for Payer: PacificSource Commercial |
$1,480.50
|
| Rate for Payer: PHCS PPO |
$1,612.10
|
| Rate for Payer: Three Rivers PPO |
$1,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,085.70
|
| Rate for Payer: United Healthcare Commercial |
$1,431.15
|
| Rate for Payer: United Healthcare Medicare |
$1,085.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,562.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,562.75
|
|
|
HC UNSPECIFIED MOLECULAR PATH PROCEDURE - LCHAD MUTATION
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
3108147902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$906.40 |
| Max. Negotiated Rate |
$1,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,612.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,085.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,579.20
|
| Rate for Payer: Altius Commercial |
$1,579.20
|
| Rate for Payer: Beech Street Commercial |
$1,612.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,350.54
|
| Rate for Payer: Cash Price |
$1,151.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,595.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,612.10
|
| Rate for Payer: Entrust Commercial |
$1,562.75
|
| Rate for Payer: First Choice Health Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,562.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$954.10
|
| Rate for Payer: HealthUtah PPO |
$1,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,595.65
|
| Rate for Payer: Multiplan Medicare/VA |
$906.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,612.10
|
| Rate for Payer: PacificSource Commercial |
$1,480.50
|
| Rate for Payer: PHCS PPO |
$1,612.10
|
| Rate for Payer: Three Rivers PPO |
$1,233.75
|
| Rate for Payer: TriWest Veterans Administration |
$954.10
|
| Rate for Payer: United Healthcare Commercial |
$1,431.15
|
| Rate for Payer: United Healthcare Medicare |
$954.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,612.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,562.75
|
|
|
HC UPR/LXTR ART STDY 3+ LVLS - CV US ANKLE/BRACHIAL INDICES EXTREM LMTD
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
9219392302
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$504.74 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$772.80
|
| Rate for Payer: Altius Commercial |
$772.80
|
| Rate for Payer: Beech Street Commercial |
$788.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$660.90
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: Entrust Commercial |
$764.75
|
| Rate for Payer: First Choice Health Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$531.30
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$504.74
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$788.90
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$531.30
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
| Rate for Payer: WINHealth Partners Commercial |
$764.75
|
| Rate for Payer: Wise Provider Network Commercial |
$764.75
|
|
|
HC UPR/LXTR ART STDY 3+ LVLS - CV US ANKLE/BRACHIAL INDICES EXTREM LMTD
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
9219392302
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$443.56 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$531.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$772.80
|
| Rate for Payer: Altius Commercial |
$772.80
|
| Rate for Payer: Beech Street Commercial |
$788.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$660.90
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: Entrust Commercial |
$764.75
|
| Rate for Payer: First Choice Health Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.90
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$443.56
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$788.90
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$466.90
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$466.90
|
| Rate for Payer: WINHealth Partners Commercial |
$788.90
|
| Rate for Payer: Wise Provider Network Commercial |
$764.75
|
|
|
HC UPR/L XTREMITY ART 2 LEVELS - CV US ANKLE BRACHIAL INDICES EXTRM CMP
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$385.70 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$462.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$385.70
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$406.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$406.00
|
| Rate for Payer: WINHealth Partners Commercial |
$686.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC UPR/L XTREMITY ART 2 LEVELS - CV US ANKLE BRACHIAL INDICES EXTRM CMP
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$438.90
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$462.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC UPR/L XTREMITY ART 2 LEVELS - TRANSCUTANEOUS O2 MEASUREMENT
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392202
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$438.90
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$462.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC UPR/L XTREMITY ART 2 LEVELS - TRANSCUTANEOUS O2 MEASUREMENT
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392202
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$385.70 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Aetna of WY Medicare |
$462.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
| Rate for Payer: Altius Commercial |
$672.00
|
| Rate for Payer: Beech Street Commercial |
$686.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: Entrust Commercial |
$665.00
|
| Rate for Payer: First Choice Health Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: Multiplan Medicare/VA |
$385.70
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$686.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: TriWest Veterans Administration |
$406.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicare |
$406.00
|
| Rate for Payer: WINHealth Partners Commercial |
$686.00
|
| Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
|
HC UPR/L XTREMITY ART 2 LEVELS - TRANSCUTANEOUS O2 MEASURE W/ BRACHIAL INDEX
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
4029389301
|
|
Hospital Revenue Code
|
402
|
| 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 UPR/L XTREMITY ART 2 LEVELS - TRANSCUTANEOUS O2 MEASURE W/ BRACHIAL INDEX
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
4029389301
|
|
Hospital Revenue Code
|
402
|
| 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 URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| 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 URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| 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 URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$13.78
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$14.50
|
| Rate for Payer: WINHealth Partners Commercial |
$24.50
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.50
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$15.68
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.50
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$16.50
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC URINE ALBUMIN SEMIQUANTITATIVE - 24 HOURS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
3018204401
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
