|
HC ALPHA DEFENSIN, SYNOVIAL FLUID LFA IA
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 83518
|
| Hospital Charge Code |
3018351801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 82107
|
| Hospital Charge Code |
3018210701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$335.44 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$513.60
|
| Rate for Payer: Altius Commercial |
$513.60
|
| Rate for Payer: Beech Street Commercial |
$524.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$439.24
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.95
|
| Rate for Payer: Cigna of WY Commercial |
$524.30
|
| Rate for Payer: Entrust Commercial |
$508.25
|
| Rate for Payer: First Choice Health Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.10
|
| Rate for Payer: HealthUtah PPO |
$535.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.95
|
| Rate for Payer: Multiplan Medicare/VA |
$335.44
|
| Rate for Payer: One Health Plan of WY PPO |
$524.30
|
| Rate for Payer: PacificSource Commercial |
$481.50
|
| Rate for Payer: PHCS PPO |
$524.30
|
| Rate for Payer: Three Rivers PPO |
$401.25
|
| Rate for Payer: TriWest Veterans Administration |
$353.10
|
| Rate for Payer: United Healthcare Commercial |
$465.45
|
| Rate for Payer: United Healthcare Medicare |
$353.10
|
| Rate for Payer: WINHealth Partners Commercial |
$508.25
|
| Rate for Payer: Wise Provider Network Commercial |
$508.25
|
|
|
HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 82107
|
| Hospital Charge Code |
3018210701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$294.78 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.30
|
| Rate for Payer: Aetna of WY Medicare |
$353.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$513.60
|
| Rate for Payer: Altius Commercial |
$513.60
|
| Rate for Payer: Beech Street Commercial |
$524.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$439.24
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.95
|
| Rate for Payer: Cigna of WY Commercial |
$524.30
|
| Rate for Payer: Entrust Commercial |
$508.25
|
| Rate for Payer: First Choice Health Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.30
|
| Rate for Payer: HealthUtah PPO |
$535.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.95
|
| Rate for Payer: Multiplan Medicare/VA |
$294.78
|
| Rate for Payer: One Health Plan of WY PPO |
$524.30
|
| Rate for Payer: PacificSource Commercial |
$481.50
|
| Rate for Payer: PHCS PPO |
$524.30
|
| Rate for Payer: Three Rivers PPO |
$401.25
|
| Rate for Payer: TriWest Veterans Administration |
$310.30
|
| Rate for Payer: United Healthcare Commercial |
$465.45
|
| Rate for Payer: United Healthcare Medicare |
$310.30
|
| Rate for Payer: WINHealth Partners Commercial |
$524.30
|
| Rate for Payer: Wise Provider Network Commercial |
$508.25
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ALS LEVEL 2
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS A0433
|
| Hospital Charge Code |
540A043301
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,622.70 |
| Max. Negotiated Rate |
$2,945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,886.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,943.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,827.20
|
| Rate for Payer: Altius Commercial |
$2,827.20
|
| Rate for Payer: Beech Street Commercial |
$2,886.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,417.84
|
| Rate for Payer: Cash Price |
$2,061.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,856.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,886.10
|
| Rate for Payer: Entrust Commercial |
$2,797.75
|
| Rate for Payer: First Choice Health Commercial |
$2,797.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,797.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,708.10
|
| Rate for Payer: HealthUtah PPO |
$2,945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,856.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,622.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,886.10
|
| Rate for Payer: PacificSource Commercial |
$2,650.50
|
| Rate for Payer: PHCS PPO |
$2,886.10
|
| Rate for Payer: Three Rivers PPO |
$2,208.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,708.10
|
| Rate for Payer: United Healthcare Commercial |
$2,562.15
|
| Rate for Payer: United Healthcare Medicare |
$1,708.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,886.10
|
| Rate for Payer: Wise Provider Network Commercial |
$2,797.75
|
|
|
HC ALS LEVEL 2
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS A0433
|
| Hospital Charge Code |
540A043301
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,846.52 |
| Max. Negotiated Rate |
$2,945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,886.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,827.20
|
| Rate for Payer: Altius Commercial |
$2,827.20
|
| Rate for Payer: Beech Street Commercial |
$2,886.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,417.84
|
| Rate for Payer: Cash Price |
$2,061.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,856.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,886.10
|
| Rate for Payer: Entrust Commercial |
$2,797.75
|
| Rate for Payer: First Choice Health Commercial |
$2,797.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,797.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,943.70
|
| Rate for Payer: HealthUtah PPO |
$2,945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,856.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,846.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,886.10
|
| Rate for Payer: PacificSource Commercial |
$2,650.50
|
| Rate for Payer: PHCS PPO |
$2,886.10
|
| Rate for Payer: Three Rivers PPO |
$2,208.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,943.70
|
| Rate for Payer: United Healthcare Commercial |
$2,562.15
|
| Rate for Payer: United Healthcare Medicare |
$1,943.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,797.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,797.75
|
|
|
HC AMBULANCE EMERGENT ALS 1
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS A0427
|
| Hospital Charge Code |
540A042701
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,464.04 |
| Max. Negotiated Rate |
$2,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,288.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,241.60
|
| Rate for Payer: Altius Commercial |
$2,241.60
|
| Rate for Payer: Beech Street Commercial |
$2,288.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,917.04
|
| Rate for Payer: Cash Price |
$1,634.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,264.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,288.30
|
| Rate for Payer: Entrust Commercial |
$2,218.25
|
| Rate for Payer: First Choice Health Commercial |
$2,218.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,218.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,541.10
|
| Rate for Payer: HealthUtah PPO |
$2,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,264.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,464.04
|
| Rate for Payer: One Health Plan of WY PPO |
$2,288.30
|
| Rate for Payer: PacificSource Commercial |
$2,101.50
|
| Rate for Payer: PHCS PPO |
$2,288.30
|
| Rate for Payer: Three Rivers PPO |
$1,751.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,541.10
|
| Rate for Payer: United Healthcare Commercial |
$2,031.45
|
| Rate for Payer: United Healthcare Medicare |
$1,541.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,218.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,218.25
|
|
|
HC AMBULANCE EMERGENT ALS 1
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS A0427
|
| Hospital Charge Code |
540A042701
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,286.58 |
| Max. Negotiated Rate |
$2,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,288.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,541.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,241.60
|
| Rate for Payer: Altius Commercial |
$2,241.60
|
| Rate for Payer: Beech Street Commercial |
$2,288.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,917.04
|
| Rate for Payer: Cash Price |
$1,634.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,264.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,288.30
|
| Rate for Payer: Entrust Commercial |
$2,218.25
|
| Rate for Payer: First Choice Health Commercial |
$2,218.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,218.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,354.30
|
| Rate for Payer: HealthUtah PPO |
$2,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,264.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1,286.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,288.30
|
| Rate for Payer: PacificSource Commercial |
$2,101.50
|
| Rate for Payer: PHCS PPO |
$2,288.30
|
| Rate for Payer: Three Rivers PPO |
$1,751.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,354.30
|
| Rate for Payer: United Healthcare Commercial |
$2,031.45
|
| Rate for Payer: United Healthcare Medicare |
$1,354.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,288.30
|
| Rate for Payer: Wise Provider Network Commercial |
$2,218.25
|
|
|
HC AMBULANCE EMERGENT BLS
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS A0429
|
| Hospital Charge Code |
540A042901
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,090.98 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,705.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,670.40
|
| Rate for Payer: Altius Commercial |
$1,670.40
|
| Rate for Payer: Beech Street Commercial |
$1,705.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,428.54
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,687.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,705.20
|
| Rate for Payer: Entrust Commercial |
$1,653.00
|
| Rate for Payer: First Choice Health Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,148.40
|
| Rate for Payer: HealthUtah PPO |
$1,740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,687.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,090.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,705.20
|
| Rate for Payer: PacificSource Commercial |
$1,566.00
|
| Rate for Payer: PHCS PPO |
$1,705.20
|
| Rate for Payer: Three Rivers PPO |
$1,305.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,148.40
|
| Rate for Payer: United Healthcare Commercial |
$1,513.80
|
| Rate for Payer: United Healthcare Medicare |
$1,148.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,653.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,653.00
|
|
|
HC AMBULANCE EMERGENT BLS
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS A0429
|
| Hospital Charge Code |
540A042901
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$958.74 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,705.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,148.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,670.40
|
| Rate for Payer: Altius Commercial |
$1,670.40
|
| Rate for Payer: Beech Street Commercial |
$1,705.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,428.54
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,687.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,705.20
|
| Rate for Payer: Entrust Commercial |
$1,653.00
|
| Rate for Payer: First Choice Health Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.20
|
| Rate for Payer: HealthUtah PPO |
$1,740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,687.80
|
| Rate for Payer: Multiplan Medicare/VA |
$958.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,705.20
|
| Rate for Payer: PacificSource Commercial |
$1,566.00
|
| Rate for Payer: PHCS PPO |
$1,705.20
|
| Rate for Payer: Three Rivers PPO |
$1,305.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.20
|
| Rate for Payer: United Healthcare Commercial |
$1,513.80
|
| Rate for Payer: United Healthcare Medicare |
$1,009.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,705.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,653.00
|
|
|
HC AMBULANCE NON EMERGENT ALS 1
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS A0426
|
| Hospital Charge Code |
540A042601
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC AMBULANCE NON EMERGENT ALS 1
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS A0426
|
| Hospital Charge Code |
540A042601
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC AMBULANCE NON EMERGENT BLS
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
540A042801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$716.30 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Aetna of WY Medicare |
$858.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$754.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$716.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$754.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$754.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,274.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC AMBULANCE NON EMERGENT BLS
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
540A042801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$815.10 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,274.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,248.00
|
| Rate for Payer: Altius Commercial |
$1,248.00
|
| Rate for Payer: Beech Street Commercial |
$1,274.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,067.30
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,261.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,274.00
|
| Rate for Payer: Entrust Commercial |
$1,235.00
|
| Rate for Payer: First Choice Health Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,235.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$858.00
|
| Rate for Payer: HealthUtah PPO |
$1,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,261.00
|
| Rate for Payer: Multiplan Medicare/VA |
$815.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,274.00
|
| Rate for Payer: PacificSource Commercial |
$1,170.00
|
| Rate for Payer: PHCS PPO |
$1,274.00
|
| Rate for Payer: Three Rivers PPO |
$975.00
|
| Rate for Payer: TriWest Veterans Administration |
$858.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.00
|
| Rate for Payer: United Healthcare Medicare |
$858.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,235.00
|
|
|
HC AMBULANCE RESPONSE W TX NO TRANSPORT
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
HCPCS A0998
|
| Hospital Charge Code |
540A099801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$724.18 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.26
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$762.30
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$724.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$762.30
|
| Rate for Payer: United Healthcare Commercial |
$1,004.85
|
| Rate for Payer: United Healthcare Medicare |
$762.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
HC AMBULANCE RESPONSE W TX NO TRANSPORT
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
HCPCS A0998
|
| Hospital Charge Code |
540A099801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$636.40 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,131.90
|
| Rate for Payer: Aetna of WY Medicare |
$762.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,108.80
|
| Rate for Payer: Altius Commercial |
$1,108.80
|
| Rate for Payer: Beech Street Commercial |
$1,131.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$948.26
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,120.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,131.90
|
| Rate for Payer: Entrust Commercial |
$1,097.25
|
| Rate for Payer: First Choice Health Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,097.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$1,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,120.35
|
| Rate for Payer: Multiplan Medicare/VA |
$636.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,131.90
|
| Rate for Payer: PacificSource Commercial |
$1,039.50
|
| Rate for Payer: PHCS PPO |
$1,131.90
|
| Rate for Payer: Three Rivers PPO |
$866.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$1,004.85
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,131.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,097.25
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Aetna of WY Medicare |
$135.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.90
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$112.96
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.90
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$118.90
|
| Rate for Payer: WINHealth Partners Commercial |
$200.90
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.80
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.30
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.30
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$128.54
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$135.30
|
| Rate for Payer: United Healthcare Commercial |
$178.35
|
| Rate for Payer: United Healthcare Medicare |
$135.30
|
| Rate for Payer: WINHealth Partners Commercial |
$194.75
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
