|
HC BACTERIUM, ANTIBODY - TRICHODERM VIRIDE IGG
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
3028660908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| 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 |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| 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 |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC BARTONELLA, ANTIBODY - BARTONELLA AB IGG
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661102
|
|
Hospital Revenue Code
|
302
|
| 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 BARTONELLA, ANTIBODY - BARTONELLA AB IGG
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661102
|
|
Hospital Revenue Code
|
302
|
| 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 BARTONELLA, ANTIBODY - BARTONELLA AB IGM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661103
|
|
Hospital Revenue Code
|
302
|
| 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 BARTONELLA, ANTIBODY - BARTONELLA AB IGM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661103
|
|
Hospital Revenue Code
|
302
|
| 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 BARTONELLA, ANTIBODY - BARTONELLA AB PANEL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661101
|
|
Hospital Revenue Code
|
302
|
| 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 BARTONELLA, ANTIBODY - BARTONELLA AB PANEL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
3028661101
|
|
Hospital Revenue Code
|
302
|
| 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 BASIC METABOLIC PANEL CALCIUM TOTAL
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
3018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC BASIC METABOLIC PANEL CALCIUM TOTAL
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
3018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC B CELLS, TOTAL COUNT - B CELLS, TOTAL COUNT
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
3028635501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$217.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.40
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC B CELLS, TOTAL COUNT - B CELLS, TOTAL COUNT
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
3028635501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.80
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$206.91
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$217.80
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC BEHAVIOR HEALTH IVNTJ FAM W/O PT F2F 1ST 30 MIN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 96170
|
| Hospital Charge Code |
9009617001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: Optum Behavioral Health Commercial |
$71.28
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC BEHAVIOR HEALTH IVNTJ FAM W/O PT F2F 1ST 30 MIN
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 96170
|
| Hospital Charge Code |
9009617001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC BEHAVIOR HEALTH IVNTJ FAM W/O PT F2F EA ADDL 15
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 96171
|
| Hospital Charge Code |
9009617101
|
|
Hospital Revenue Code
|
900
|
| 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 BEHAVIOR HEALTH IVNTJ FAM W/O PT F2F EA ADDL 15
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 96171
|
| Hospital Charge Code |
9009617101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$25.81 |
| 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: 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: Optum Behavioral Health Commercial |
$25.81
|
| 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 BEHAVIOR HEALTH IVNTJ FAM W/PT F2F 1ST 30 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 96167
|
| Hospital Charge Code |
9009616701
|
|
Hospital Revenue Code
|
900
|
| 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 BEHAVIOR HEALTH IVNTJ FAM W/PT F2F 1ST 30 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 96167
|
| Hospital Charge Code |
9009616701
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$63.43 |
| 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: 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: Optum Behavioral Health Commercial |
$63.43
|
| 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 BEHAVIOR HEALTH IVNTJ GROUP F2F 1ST 30 MIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 96164
|
| Hospital Charge Code |
9009616401
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$8.93 |
| 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: 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: Optum Behavioral Health Commercial |
$8.93
|
| 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 BEHAVIOR HEALTH IVNTJ GROUP F2F 1ST 30 MIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 96164
|
| Hospital Charge Code |
9009616401
|
|
Hospital Revenue Code
|
900
|
| 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 BEHAVIOR HEALTH IVNTJ GROUP F2F EA ADDL 15 MIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS 96165
|
| Hospital Charge Code |
9009616501
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.60
|
| Rate for Payer: Altius Commercial |
$9.60
|
| Rate for Payer: Beech Street Commercial |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.21
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.70
|
| Rate for Payer: Cigna of WY Commercial |
$9.80
|
| Rate for Payer: Entrust Commercial |
$9.50
|
| Rate for Payer: First Choice Health Commercial |
$9.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.60
|
| Rate for Payer: HealthUtah PPO |
$10.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.70
|
| Rate for Payer: Multiplan Medicare/VA |
$6.27
|
| Rate for Payer: One Health Plan of WY PPO |
$9.80
|
| Rate for Payer: PacificSource Commercial |
$9.00
|
| Rate for Payer: PHCS PPO |
$9.80
|
| Rate for Payer: Three Rivers PPO |
$7.50
|
| Rate for Payer: TriWest Veterans Administration |
$6.60
|
| Rate for Payer: United Healthcare Commercial |
$8.70
|
| Rate for Payer: United Healthcare Medicare |
$6.60
|
| Rate for Payer: WINHealth Partners Commercial |
$9.50
|
| Rate for Payer: Wise Provider Network Commercial |
$9.50
|
|
|
HC BEHAVIOR HEALTH IVNTJ GROUP F2F EA ADDL 15 MIN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 96165
|
| Hospital Charge Code |
9009616501
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.80
|
| Rate for Payer: Aetna of WY Medicare |
$6.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.60
|
| Rate for Payer: Altius Commercial |
$9.60
|
| Rate for Payer: Beech Street Commercial |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.21
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.70
|
| Rate for Payer: Cigna of WY Commercial |
$9.80
|
| Rate for Payer: Entrust Commercial |
$9.50
|
| Rate for Payer: First Choice Health Commercial |
$9.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.80
|
| Rate for Payer: HealthUtah PPO |
$10.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.70
|
| Rate for Payer: Multiplan Medicare/VA |
$5.51
|
| Rate for Payer: One Health Plan of WY PPO |
$9.80
|
| Rate for Payer: Optum Behavioral Health Commercial |
$4.03
|
| Rate for Payer: PacificSource Commercial |
$9.00
|
| Rate for Payer: PHCS PPO |
$9.80
|
| Rate for Payer: Three Rivers PPO |
$7.50
|
| Rate for Payer: TriWest Veterans Administration |
$5.80
|
| Rate for Payer: United Healthcare Commercial |
$8.70
|
| Rate for Payer: United Healthcare Medicare |
$5.80
|
| Rate for Payer: WINHealth Partners Commercial |
$9.80
|
| Rate for Payer: Wise Provider Network Commercial |
$9.50
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$180.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$176.64
|
| Rate for Payer: Altius Commercial |
$176.64
|
| Rate for Payer: Beech Street Commercial |
$180.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.06
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$178.48
|
| Rate for Payer: Cigna of WY Commercial |
$180.32
|
| Rate for Payer: Entrust Commercial |
$174.80
|
| Rate for Payer: First Choice Health Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.44
|
| Rate for Payer: HealthUtah PPO |
$184.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$178.48
|
| Rate for Payer: Multiplan Medicare/VA |
$115.37
|
| Rate for Payer: One Health Plan of WY PPO |
$180.32
|
| Rate for Payer: PacificSource Commercial |
$165.60
|
| Rate for Payer: PHCS PPO |
$180.32
|
| Rate for Payer: Three Rivers PPO |
$138.00
|
| Rate for Payer: TriWest Veterans Administration |
$121.44
|
| Rate for Payer: United Healthcare Commercial |
$160.08
|
| Rate for Payer: United Healthcare Medicare |
$121.44
|
| Rate for Payer: WINHealth Partners Commercial |
$174.80
|
| Rate for Payer: Wise Provider Network Commercial |
$174.80
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.38 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$180.32
|
| Rate for Payer: Aetna of WY Medicare |
$121.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$176.64
|
| Rate for Payer: Altius Commercial |
$176.64
|
| Rate for Payer: Beech Street Commercial |
$180.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.06
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$178.48
|
| Rate for Payer: Cigna of WY Commercial |
$180.32
|
| Rate for Payer: Entrust Commercial |
$174.80
|
| Rate for Payer: First Choice Health Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.72
|
| Rate for Payer: HealthUtah PPO |
$184.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$178.48
|
| Rate for Payer: Multiplan Medicare/VA |
$101.38
|
| Rate for Payer: One Health Plan of WY PPO |
$180.32
|
| Rate for Payer: PacificSource Commercial |
$165.60
|
| Rate for Payer: PHCS PPO |
$180.32
|
| Rate for Payer: Three Rivers PPO |
$138.00
|
| Rate for Payer: TriWest Veterans Administration |
$106.72
|
| Rate for Payer: United Healthcare Commercial |
$160.08
|
| Rate for Payer: United Healthcare Medicare |
$106.72
|
| Rate for Payer: WINHealth Partners Commercial |
$180.32
|
| Rate for Payer: Wise Provider Network Commercial |
$174.80
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY - GLYCOPROTEIN IGA
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3008614603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC BETA 2 GLYCOPROTEIN I ANTIBODY - GLYCOPROTEIN IGA
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3028614603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
