HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS
|
Facility
|
OP
|
$210.00
|
|
Service Code
|
HCPCS 86606
|
Hospital Charge Code |
3028660601
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$115.71 |
Max. Negotiated Rate |
$210.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
Rate for Payer: Aetna of WY Medicare |
$138.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
Rate for Payer: Altius Commercial |
$201.60
|
Rate for Payer: Beech Street Commercial |
$205.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
Rate for Payer: Cash Price |
$147.00
|
Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
Rate for Payer: Cigna of WY Commercial |
$205.80
|
Rate for Payer: Entrust Commercial |
$199.50
|
Rate for Payer: First Choice Health Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
Rate for Payer: HealthUtah PPO |
$210.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
Rate for Payer: Multiplan Medicare/VA |
$115.71
|
Rate for Payer: One Health Plan of WY PPO |
$205.80
|
Rate for Payer: PacificSource Commercial |
$189.00
|
Rate for Payer: PHCS PPO |
$205.80
|
Rate for Payer: Three Rivers PPO |
$157.50
|
Rate for Payer: TriWest Veterans Administration |
$121.80
|
Rate for Payer: United Healthcare Commercial |
$182.70
|
Rate for Payer: United Healthcare Medicare |
$121.80
|
Rate for Payer: WINHealth Partners Commercial |
$205.80
|
Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS
|
Facility
|
IP
|
$210.00
|
|
Service Code
|
HCPCS 86606
|
Hospital Charge Code |
3028660601
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$131.67 |
Max. Negotiated Rate |
$210.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
Rate for Payer: Altius Commercial |
$201.60
|
Rate for Payer: Beech Street Commercial |
$205.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
Rate for Payer: Cash Price |
$147.00
|
Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
Rate for Payer: Cigna of WY Commercial |
$205.80
|
Rate for Payer: Entrust Commercial |
$199.50
|
Rate for Payer: First Choice Health Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
Rate for Payer: HealthUtah PPO |
$210.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
Rate for Payer: Multiplan Medicare/VA |
$131.67
|
Rate for Payer: One Health Plan of WY PPO |
$205.80
|
Rate for Payer: PacificSource Commercial |
$189.00
|
Rate for Payer: PHCS PPO |
$205.80
|
Rate for Payer: Three Rivers PPO |
$157.50
|
Rate for Payer: TriWest Veterans Administration |
$138.60
|
Rate for Payer: United Healthcare Commercial |
$182.70
|
Rate for Payer: United Healthcare Medicare |
$138.60
|
Rate for Payer: WINHealth Partners Commercial |
$199.50
|
Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
IP
|
$41.00
|
|
Service Code
|
HCPCS 20612
|
Hospital Charge Code |
5102061201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$25.71 |
Max. Negotiated Rate |
$41.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
Rate for Payer: Altius Commercial |
$39.36
|
Rate for Payer: Beech Street Commercial |
$40.18
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
Rate for Payer: Cash Price |
$28.70
|
Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
Rate for Payer: Cigna of WY Commercial |
$40.18
|
Rate for Payer: Entrust Commercial |
$38.95
|
Rate for Payer: First Choice Health Commercial |
$38.95
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.06
|
Rate for Payer: HealthUtah PPO |
$41.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
Rate for Payer: Multiplan Medicare/VA |
$25.71
|
Rate for Payer: One Health Plan of WY PPO |
$40.18
|
Rate for Payer: PacificSource Commercial |
$36.90
|
Rate for Payer: PHCS PPO |
$40.18
|
Rate for Payer: Three Rivers PPO |
$30.75
|
Rate for Payer: TriWest Veterans Administration |
$27.06
|
Rate for Payer: United Healthcare Commercial |
$35.67
|
Rate for Payer: United Healthcare Medicare |
$27.06
|
Rate for Payer: WINHealth Partners Commercial |
$38.95
|
Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
IP
|
$331.00
|
|
Service Code
|
HCPCS 20612
|
Hospital Charge Code |
3612061201
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$207.54 |
Max. Negotiated Rate |
$331.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
Rate for Payer: Altius Commercial |
$317.76
|
Rate for Payer: Beech Street Commercial |
$324.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
Rate for Payer: Cash Price |
$231.70
|
Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
Rate for Payer: Cigna of WY Commercial |
$324.38
|
Rate for Payer: Entrust Commercial |
$314.45
|
Rate for Payer: First Choice Health Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
Rate for Payer: HealthUtah PPO |
$331.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
Rate for Payer: Multiplan Medicare/VA |
$207.54
|
Rate for Payer: One Health Plan of WY PPO |
$324.38
|
Rate for Payer: PacificSource Commercial |
$297.90
|
Rate for Payer: PHCS PPO |
$324.38
|
Rate for Payer: Three Rivers PPO |
$248.25
|
Rate for Payer: TriWest Veterans Administration |
$218.46
|
Rate for Payer: United Healthcare Commercial |
$287.97
|
Rate for Payer: United Healthcare Medicare |
$218.46
|
Rate for Payer: WINHealth Partners Commercial |
$314.45
|
Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
OP
|
$41.00
|
|
Service Code
|
HCPCS 20612
|
Hospital Charge Code |
5102061201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$22.59 |
Max. Negotiated Rate |
$41.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
Rate for Payer: Aetna of WY Medicare |
$27.06
|
Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
Rate for Payer: Altius Commercial |
$39.36
|
Rate for Payer: Beech Street Commercial |
$40.18
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
Rate for Payer: Cash Price |
$28.70
|
Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
Rate for Payer: Cigna of WY Commercial |
$40.18
|
Rate for Payer: Entrust Commercial |
$38.95
|
Rate for Payer: First Choice Health Commercial |
$38.95
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.78
|
Rate for Payer: HealthUtah PPO |
$41.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
Rate for Payer: Multiplan Medicare/VA |
$22.59
|
Rate for Payer: One Health Plan of WY PPO |
$40.18
|
Rate for Payer: PacificSource Commercial |
$36.90
|
Rate for Payer: PHCS PPO |
$40.18
|
Rate for Payer: Three Rivers PPO |
$30.75
|
Rate for Payer: TriWest Veterans Administration |
$23.78
|
Rate for Payer: United Healthcare Commercial |
$35.67
|
Rate for Payer: United Healthcare Medicare |
$23.78
|
Rate for Payer: WINHealth Partners Commercial |
$40.18
|
Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
OP
|
$331.00
|
|
Service Code
|
HCPCS 20612
|
Hospital Charge Code |
3612061201
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$182.38 |
Max. Negotiated Rate |
$331.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
Rate for Payer: Aetna of WY Medicare |
$218.46
|
Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
Rate for Payer: Altius Commercial |
$317.76
|
Rate for Payer: Beech Street Commercial |
$324.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
Rate for Payer: Cash Price |
$231.70
|
Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
Rate for Payer: Cigna of WY Commercial |
$324.38
|
Rate for Payer: Entrust Commercial |
$314.45
|
Rate for Payer: First Choice Health Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
Rate for Payer: HealthUtah PPO |
$331.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
Rate for Payer: Multiplan Medicare/VA |
$182.38
|
Rate for Payer: One Health Plan of WY PPO |
$324.38
|
Rate for Payer: PacificSource Commercial |
$297.90
|
Rate for Payer: PHCS PPO |
$324.38
|
Rate for Payer: Three Rivers PPO |
$248.25
|
Rate for Payer: TriWest Veterans Administration |
$191.98
|
Rate for Payer: United Healthcare Commercial |
$287.97
|
Rate for Payer: United Healthcare Medicare |
$191.98
|
Rate for Payer: WINHealth Partners Commercial |
$324.38
|
Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$151.00
|
|
Service Code
|
HCPCS 51102
|
Hospital Charge Code |
5105110201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$94.68 |
Max. Negotiated Rate |
$151.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
Rate for Payer: Altius Commercial |
$144.96
|
Rate for Payer: Beech Street Commercial |
$147.98
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
Rate for Payer: Cash Price |
$105.70
|
Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
Rate for Payer: Cigna of WY Commercial |
$147.98
|
Rate for Payer: Entrust Commercial |
$143.45
|
Rate for Payer: First Choice Health Commercial |
$143.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.66
|
Rate for Payer: HealthUtah PPO |
$151.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
Rate for Payer: Multiplan Medicare/VA |
$94.68
|
Rate for Payer: One Health Plan of WY PPO |
$147.98
|
Rate for Payer: PacificSource Commercial |
$135.90
|
Rate for Payer: PHCS PPO |
$147.98
|
Rate for Payer: Three Rivers PPO |
$113.25
|
Rate for Payer: TriWest Veterans Administration |
$99.66
|
Rate for Payer: United Healthcare Commercial |
$131.37
|
Rate for Payer: United Healthcare Medicare |
$99.66
|
Rate for Payer: WINHealth Partners Commercial |
$143.45
|
Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$151.00
|
|
Service Code
|
HCPCS 51102
|
Hospital Charge Code |
5105110201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$83.20 |
Max. Negotiated Rate |
$151.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
Rate for Payer: Aetna of WY Medicare |
$99.66
|
Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
Rate for Payer: Altius Commercial |
$144.96
|
Rate for Payer: Beech Street Commercial |
$147.98
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
Rate for Payer: Cash Price |
$105.70
|
Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
Rate for Payer: Cigna of WY Commercial |
$147.98
|
Rate for Payer: Entrust Commercial |
$143.45
|
Rate for Payer: First Choice Health Commercial |
$143.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.58
|
Rate for Payer: HealthUtah PPO |
$151.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
Rate for Payer: Multiplan Medicare/VA |
$83.20
|
Rate for Payer: One Health Plan of WY PPO |
$147.98
|
Rate for Payer: PacificSource Commercial |
$135.90
|
Rate for Payer: PHCS PPO |
$147.98
|
Rate for Payer: Three Rivers PPO |
$113.25
|
Rate for Payer: TriWest Veterans Administration |
$87.58
|
Rate for Payer: United Healthcare Commercial |
$131.37
|
Rate for Payer: United Healthcare Medicare |
$87.58
|
Rate for Payer: WINHealth Partners Commercial |
$147.98
|
Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
HC ASPIRATION BLADDER NEEDLE
|
Facility
|
IP
|
$52.00
|
|
Service Code
|
HCPCS 51100
|
Hospital Charge Code |
5105110001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$32.60 |
Max. Negotiated Rate |
$52.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
Rate for Payer: Altius Commercial |
$49.92
|
Rate for Payer: Beech Street Commercial |
$50.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
Rate for Payer: Cash Price |
$36.40
|
Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
Rate for Payer: Cigna of WY Commercial |
$50.96
|
Rate for Payer: Entrust Commercial |
$49.40
|
Rate for Payer: First Choice Health Commercial |
$49.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.32
|
Rate for Payer: HealthUtah PPO |
$52.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
Rate for Payer: Multiplan Medicare/VA |
$32.60
|
Rate for Payer: One Health Plan of WY PPO |
$50.96
|
Rate for Payer: PacificSource Commercial |
$46.80
|
Rate for Payer: PHCS PPO |
$50.96
|
Rate for Payer: Three Rivers PPO |
$39.00
|
Rate for Payer: TriWest Veterans Administration |
$34.32
|
Rate for Payer: United Healthcare Commercial |
$45.24
|
Rate for Payer: United Healthcare Medicare |
$34.32
|
Rate for Payer: WINHealth Partners Commercial |
$49.40
|
Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
HC ASPIRATION BLADDER NEEDLE
|
Facility
|
OP
|
$52.00
|
|
Service Code
|
HCPCS 51100
|
Hospital Charge Code |
5105110001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$28.65 |
Max. Negotiated Rate |
$52.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
Rate for Payer: Aetna of WY Medicare |
$34.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
Rate for Payer: Altius Commercial |
$49.92
|
Rate for Payer: Beech Street Commercial |
$50.96
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
Rate for Payer: Cash Price |
$36.40
|
Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
Rate for Payer: Cigna of WY Commercial |
$50.96
|
Rate for Payer: Entrust Commercial |
$49.40
|
Rate for Payer: First Choice Health Commercial |
$49.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.16
|
Rate for Payer: HealthUtah PPO |
$52.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
Rate for Payer: Multiplan Medicare/VA |
$28.65
|
Rate for Payer: One Health Plan of WY PPO |
$50.96
|
Rate for Payer: PacificSource Commercial |
$46.80
|
Rate for Payer: PHCS PPO |
$50.96
|
Rate for Payer: Three Rivers PPO |
$39.00
|
Rate for Payer: TriWest Veterans Administration |
$30.16
|
Rate for Payer: United Healthcare Commercial |
$45.24
|
Rate for Payer: United Healthcare Medicare |
$30.16
|
Rate for Payer: WINHealth Partners Commercial |
$50.96
|
Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
HC ASSAY 17-(17-KS)KETOSTEROIDS - 17 KETOSTEROIDS,24HR URINE
|
Facility
|
OP
|
$115.00
|
|
Service Code
|
HCPCS 83586
|
Hospital Charge Code |
3018358601
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$63.36 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Aetna of WY Medicare |
$75.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$63.36
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$66.70
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$66.70
|
Rate for Payer: WINHealth Partners Commercial |
$112.70
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC ASSAY 17-(17-KS)KETOSTEROIDS - 17 KETOSTEROIDS,24HR URINE
|
Facility
|
IP
|
$115.00
|
|
Service Code
|
HCPCS 83586
|
Hospital Charge Code |
3018358601
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$72.10 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$72.10
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$75.90
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$75.90
|
Rate for Payer: WINHealth Partners Commercial |
$109.25
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC ASSAY ADENOVIRUS ANTIGEN STOOL
|
Facility
|
IP
|
$106.00
|
|
Service Code
|
HCPCS 87301
|
Hospital Charge Code |
3008730101
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$66.46 |
Max. Negotiated Rate |
$106.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$101.76
|
Rate for Payer: Altius Commercial |
$101.76
|
Rate for Payer: Beech Street Commercial |
$103.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.03
|
Rate for Payer: Cash Price |
$74.20
|
Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
Rate for Payer: Cigna of WY Commercial |
$103.88
|
Rate for Payer: Entrust Commercial |
$100.70
|
Rate for Payer: First Choice Health Commercial |
$100.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.96
|
Rate for Payer: HealthUtah PPO |
$106.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
Rate for Payer: Multiplan Medicare/VA |
$66.46
|
Rate for Payer: One Health Plan of WY PPO |
$103.88
|
Rate for Payer: PacificSource Commercial |
$95.40
|
Rate for Payer: PHCS PPO |
$103.88
|
Rate for Payer: Three Rivers PPO |
$79.50
|
Rate for Payer: TriWest Veterans Administration |
$69.96
|
Rate for Payer: United Healthcare Commercial |
$92.22
|
Rate for Payer: United Healthcare Medicare |
$69.96
|
Rate for Payer: WINHealth Partners Commercial |
$100.70
|
Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
HC ASSAY ADENOVIRUS ANTIGEN STOOL
|
Facility
|
OP
|
$106.00
|
|
Service Code
|
HCPCS 87301
|
Hospital Charge Code |
3008730101
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$58.41 |
Max. Negotiated Rate |
$106.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
Rate for Payer: Aetna of WY Medicare |
$69.96
|
Rate for Payer: Altius Auto/Workers Compensation |
$101.76
|
Rate for Payer: Altius Commercial |
$101.76
|
Rate for Payer: Beech Street Commercial |
$103.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.03
|
Rate for Payer: Cash Price |
$74.20
|
Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
Rate for Payer: Cigna of WY Commercial |
$103.88
|
Rate for Payer: Entrust Commercial |
$100.70
|
Rate for Payer: First Choice Health Commercial |
$100.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.48
|
Rate for Payer: HealthUtah PPO |
$106.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
Rate for Payer: Multiplan Medicare/VA |
$58.41
|
Rate for Payer: One Health Plan of WY PPO |
$103.88
|
Rate for Payer: PacificSource Commercial |
$95.40
|
Rate for Payer: PHCS PPO |
$103.88
|
Rate for Payer: Three Rivers PPO |
$79.50
|
Rate for Payer: TriWest Veterans Administration |
$61.48
|
Rate for Payer: United Healthcare Commercial |
$92.22
|
Rate for Payer: United Healthcare Medicare |
$61.48
|
Rate for Payer: WINHealth Partners Commercial |
$103.88
|
Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$60.00
|
|
Service Code
|
HCPCS 84075
|
Hospital Charge Code |
3018407501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$37.62 |
Max. Negotiated Rate |
$60.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
Rate for Payer: Altius Commercial |
$57.60
|
Rate for Payer: Beech Street Commercial |
$58.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
Rate for Payer: Cash Price |
$42.00
|
Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
Rate for Payer: Cigna of WY Commercial |
$58.80
|
Rate for Payer: Entrust Commercial |
$57.00
|
Rate for Payer: First Choice Health Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
Rate for Payer: HealthUtah PPO |
$60.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
Rate for Payer: Multiplan Medicare/VA |
$37.62
|
Rate for Payer: One Health Plan of WY PPO |
$58.80
|
Rate for Payer: PacificSource Commercial |
$54.00
|
Rate for Payer: PHCS PPO |
$58.80
|
Rate for Payer: Three Rivers PPO |
$45.00
|
Rate for Payer: TriWest Veterans Administration |
$39.60
|
Rate for Payer: United Healthcare Commercial |
$52.20
|
Rate for Payer: United Healthcare Medicare |
$39.60
|
Rate for Payer: WINHealth Partners Commercial |
$57.00
|
Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$60.00
|
|
Service Code
|
HCPCS 84075
|
Hospital Charge Code |
3018407501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$33.06 |
Max. Negotiated Rate |
$60.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
Rate for Payer: Aetna of WY Medicare |
$39.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
Rate for Payer: Altius Commercial |
$57.60
|
Rate for Payer: Beech Street Commercial |
$58.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
Rate for Payer: Cash Price |
$42.00
|
Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
Rate for Payer: Cigna of WY Commercial |
$58.80
|
Rate for Payer: Entrust Commercial |
$57.00
|
Rate for Payer: First Choice Health Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
Rate for Payer: HealthUtah PPO |
$60.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
Rate for Payer: Multiplan Medicare/VA |
$33.06
|
Rate for Payer: One Health Plan of WY PPO |
$58.80
|
Rate for Payer: PacificSource Commercial |
$54.00
|
Rate for Payer: PHCS PPO |
$58.80
|
Rate for Payer: Three Rivers PPO |
$45.00
|
Rate for Payer: TriWest Veterans Administration |
$34.80
|
Rate for Payer: United Healthcare Commercial |
$52.20
|
Rate for Payer: United Healthcare Medicare |
$34.80
|
Rate for Payer: WINHealth Partners Commercial |
$58.80
|
Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE BONE SPECIFIC
|
Facility
|
IP
|
$60.00
|
|
Service Code
|
HCPCS 84075
|
Hospital Charge Code |
3018407504
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$37.62 |
Max. Negotiated Rate |
$60.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
Rate for Payer: Altius Commercial |
$57.60
|
Rate for Payer: Beech Street Commercial |
$58.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
Rate for Payer: Cash Price |
$42.00
|
Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
Rate for Payer: Cigna of WY Commercial |
$58.80
|
Rate for Payer: Entrust Commercial |
$57.00
|
Rate for Payer: First Choice Health Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
Rate for Payer: HealthUtah PPO |
$60.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
Rate for Payer: Multiplan Medicare/VA |
$37.62
|
Rate for Payer: One Health Plan of WY PPO |
$58.80
|
Rate for Payer: PacificSource Commercial |
$54.00
|
Rate for Payer: PHCS PPO |
$58.80
|
Rate for Payer: Three Rivers PPO |
$45.00
|
Rate for Payer: TriWest Veterans Administration |
$39.60
|
Rate for Payer: United Healthcare Commercial |
$52.20
|
Rate for Payer: United Healthcare Medicare |
$39.60
|
Rate for Payer: WINHealth Partners Commercial |
$57.00
|
Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE BONE SPECIFIC
|
Facility
|
OP
|
$60.00
|
|
Service Code
|
HCPCS 84075
|
Hospital Charge Code |
3018407504
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$33.06 |
Max. Negotiated Rate |
$60.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
Rate for Payer: Aetna of WY Medicare |
$39.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
Rate for Payer: Altius Commercial |
$57.60
|
Rate for Payer: Beech Street Commercial |
$58.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
Rate for Payer: Cash Price |
$42.00
|
Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
Rate for Payer: Cigna of WY Commercial |
$58.80
|
Rate for Payer: Entrust Commercial |
$57.00
|
Rate for Payer: First Choice Health Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
Rate for Payer: HealthUtah PPO |
$60.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
Rate for Payer: Multiplan Medicare/VA |
$33.06
|
Rate for Payer: One Health Plan of WY PPO |
$58.80
|
Rate for Payer: PacificSource Commercial |
$54.00
|
Rate for Payer: PHCS PPO |
$58.80
|
Rate for Payer: Three Rivers PPO |
$45.00
|
Rate for Payer: TriWest Veterans Administration |
$34.80
|
Rate for Payer: United Healthcare Commercial |
$52.20
|
Rate for Payer: United Healthcare Medicare |
$34.80
|
Rate for Payer: WINHealth Partners Commercial |
$58.80
|
Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
IP
|
$115.00
|
|
Service Code
|
HCPCS 84080
|
Hospital Charge Code |
3018408001
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$72.10 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$72.10
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$75.90
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$75.90
|
Rate for Payer: WINHealth Partners Commercial |
$109.25
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
OP
|
$115.00
|
|
Service Code
|
HCPCS 84080
|
Hospital Charge Code |
3018408001
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$63.36 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Aetna of WY Medicare |
$75.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$63.36
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$66.70
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$66.70
|
Rate for Payer: WINHealth Partners Commercial |
$112.70
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC ASSAY BIOTINIDASE - BIOTINIDASE LEVEL
|
Facility
|
OP
|
$150.00
|
|
Service Code
|
HCPCS 82261
|
Hospital Charge Code |
3018226101
|
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 ASSAY BIOTINIDASE - BIOTINIDASE LEVEL
|
Facility
|
IP
|
$150.00
|
|
Service Code
|
HCPCS 82261
|
Hospital Charge Code |
3018226101
|
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 ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
OP
|
$75.00
|
|
Service Code
|
HCPCS 82465
|
Hospital Charge Code |
3018246502
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$41.32 |
Max. Negotiated Rate |
$75.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
Rate for Payer: Aetna of WY Medicare |
$49.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
Rate for Payer: Altius Commercial |
$72.00
|
Rate for Payer: Beech Street Commercial |
$73.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
Rate for Payer: Cash Price |
$52.50
|
Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
Rate for Payer: Cigna of WY Commercial |
$73.50
|
Rate for Payer: Entrust Commercial |
$71.25
|
Rate for Payer: First Choice Health Commercial |
$71.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
Rate for Payer: HealthUtah PPO |
$75.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
Rate for Payer: Multiplan Medicare/VA |
$41.32
|
Rate for Payer: One Health Plan of WY PPO |
$73.50
|
Rate for Payer: PacificSource Commercial |
$67.50
|
Rate for Payer: PHCS PPO |
$73.50
|
Rate for Payer: Three Rivers PPO |
$56.25
|
Rate for Payer: TriWest Veterans Administration |
$43.50
|
Rate for Payer: United Healthcare Commercial |
$65.25
|
Rate for Payer: United Healthcare Medicare |
$43.50
|
Rate for Payer: WINHealth Partners Commercial |
$73.50
|
Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
IP
|
$75.00
|
|
Service Code
|
HCPCS 82465
|
Hospital Charge Code |
3018246502
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$47.02 |
Max. Negotiated Rate |
$75.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
Rate for Payer: Altius Commercial |
$72.00
|
Rate for Payer: Beech Street Commercial |
$73.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
Rate for Payer: Cash Price |
$52.50
|
Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
Rate for Payer: Cigna of WY Commercial |
$73.50
|
Rate for Payer: Entrust Commercial |
$71.25
|
Rate for Payer: First Choice Health Commercial |
$71.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
Rate for Payer: HealthUtah PPO |
$75.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
Rate for Payer: Multiplan Medicare/VA |
$47.02
|
Rate for Payer: One Health Plan of WY PPO |
$73.50
|
Rate for Payer: PacificSource Commercial |
$67.50
|
Rate for Payer: PHCS PPO |
$73.50
|
Rate for Payer: Three Rivers PPO |
$56.25
|
Rate for Payer: TriWest Veterans Administration |
$49.50
|
Rate for Payer: United Healthcare Commercial |
$65.25
|
Rate for Payer: United Healthcare Medicare |
$49.50
|
Rate for Payer: WINHealth Partners Commercial |
$71.25
|
Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
OP
|
$50.00
|
|
Service Code
|
HCPCS 82374
|
Hospital Charge Code |
3018237401
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$27.55 |
Max. Negotiated Rate |
$50.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
Rate for Payer: Aetna of WY Medicare |
$33.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
Rate for Payer: Altius Commercial |
$48.00
|
Rate for Payer: Beech Street Commercial |
$49.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
Rate for Payer: Cash Price |
$35.00
|
Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
Rate for Payer: Cigna of WY Commercial |
$49.00
|
Rate for Payer: Entrust Commercial |
$47.50
|
Rate for Payer: First Choice Health Commercial |
$47.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
Rate for Payer: HealthUtah PPO |
$50.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
Rate for Payer: Multiplan Medicare/VA |
$27.55
|
Rate for Payer: One Health Plan of WY PPO |
$49.00
|
Rate for Payer: PacificSource Commercial |
$45.00
|
Rate for Payer: PHCS PPO |
$49.00
|
Rate for Payer: Three Rivers PPO |
$37.50
|
Rate for Payer: TriWest Veterans Administration |
$29.00
|
Rate for Payer: United Healthcare Commercial |
$43.50
|
Rate for Payer: United Healthcare Medicare |
$29.00
|
Rate for Payer: WINHealth Partners Commercial |
$49.00
|
Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|