|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
5101173001
|
|
Hospital Revenue Code
|
510
|
| 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 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
5101173001
|
|
Hospital Revenue Code
|
510
|
| 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 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
5101173201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$17.10
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
5101173201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Aetna of WY Medicare |
$11.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.28
|
| Rate for Payer: Altius Commercial |
$17.28
|
| Rate for Payer: Beech Street Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: Entrust Commercial |
$17.10
|
| Rate for Payer: First Choice Health Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.44
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.92
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.64
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.44
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$10.44
|
| Rate for Payer: WINHealth Partners Commercial |
$17.64
|
| Rate for Payer: Wise Provider Network Commercial |
$17.10
|
|
|
HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIA CULTURE SCREEN - NASAL MRSA
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIA CULTURE SCREEN - NASAL MRSA
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIA CULTURE SCREEN - STREP CULTURE GRP A
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIA CULTURE SCREEN - STREP CULTURE GRP A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC BACTERIUM, ANTIBODY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC BACTERIUM, ANTIBODY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660903
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC BACTERIUM, ANTIBODY - LISTERIA ANTIBODY TOTAL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660909
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC BACTERIUM, ANTIBODY - LISTERIA ANTIBODY TOTAL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660909
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC BACTERIUM, ANTIBODY - SACCHAROPOLYSPORA RECTIVIRGULA
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.70
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$184.96
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.70
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - SACCHAROPOLYSPORA RECTIVIRGULA
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$194.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.10
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$162.54
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$171.10
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$171.10
|
| Rate for Payer: WINHealth Partners Commercial |
$289.10
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES CANDIDUS
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660907
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.70
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$184.96
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.70
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES CANDIDUS
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660907
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$194.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.10
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$162.54
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$171.10
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$171.10
|
| Rate for Payer: WINHealth Partners Commercial |
$289.10
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES SACCHARI
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$194.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.10
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$162.54
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$171.10
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$171.10
|
| Rate for Payer: WINHealth Partners Commercial |
$289.10
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES SACCHARI
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660906
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.70
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$184.96
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.70
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES VULGARIS
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660905
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.70
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$184.96
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.70
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - THERMOACTINOMYCES VULGARIS
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660905
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$194.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.10
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$162.54
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$171.10
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$171.10
|
| Rate for Payer: WINHealth Partners Commercial |
$289.10
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC BACTERIUM, ANTIBODY - TOXIC SHOCK SYNDROME ANTIBODY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC BACTERIUM, ANTIBODY - TOXIC SHOCK SYNDROME ANTIBODY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC BACTERIUM, ANTIBODY - TRICHODERM VIRIDE IGG
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
