|
HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$289.92
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.32
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$189.35
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: United Healthcare Medicare |
$199.32
|
| Rate for Payer: WINHealth Partners Commercial |
$286.90
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 86904
|
| Hospital Charge Code |
3008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Aetna of WY Medicare |
$199.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$289.92
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.16
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$166.40
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.16
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: United Healthcare Medicare |
$175.16
|
| Rate for Payer: WINHealth Partners Commercial |
$295.96
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC BLOOD TYPING SEROLOGIC ABO
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC BLOOD TYPING SEROLOGIC ABO
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| 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 BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| 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 BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| 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 BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| 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 BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| 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 BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
3058581001
|
|
Hospital Revenue Code
|
305
|
| 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 BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$201.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.90
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$168.06
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$176.90
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$176.90
|
| Rate for Payer: WINHealth Partners Commercial |
$298.90
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.30
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$191.24
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$201.30
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC BONE BIOPSY,TROCAR/NEEDLE DEEP
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
3502022501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC BONE BIOPSY,TROCAR/NEEDLE DEEP
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
3502022501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE
|
Facility
|
OP
|
$2,670.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
3417831501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,471.17 |
| Max. Negotiated Rate |
$2,670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,616.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,762.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,563.20
|
| Rate for Payer: Altius Commercial |
$2,563.20
|
| Rate for Payer: Beech Street Commercial |
$2,616.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,192.07
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,589.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,616.60
|
| Rate for Payer: Entrust Commercial |
$2,536.50
|
| Rate for Payer: First Choice Health Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,548.60
|
| Rate for Payer: HealthUtah PPO |
$2,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,589.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,471.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,616.60
|
| Rate for Payer: PacificSource Commercial |
$2,403.00
|
| Rate for Payer: PHCS PPO |
$2,616.60
|
| Rate for Payer: Three Rivers PPO |
$2,002.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,548.60
|
| Rate for Payer: United Healthcare Commercial |
$2,322.90
|
| Rate for Payer: United Healthcare Medicare |
$1,548.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,616.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,536.50
|
|
|
HC BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE
|
Facility
|
IP
|
$2,670.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
3417831501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,674.09 |
| Max. Negotiated Rate |
$2,670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,616.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,563.20
|
| Rate for Payer: Altius Commercial |
$2,563.20
|
| Rate for Payer: Beech Street Commercial |
$2,616.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,192.07
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,589.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,616.60
|
| Rate for Payer: Entrust Commercial |
$2,536.50
|
| Rate for Payer: First Choice Health Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,762.20
|
| Rate for Payer: HealthUtah PPO |
$2,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,589.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,674.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,616.60
|
| Rate for Payer: PacificSource Commercial |
$2,403.00
|
| Rate for Payer: PHCS PPO |
$2,616.60
|
| Rate for Payer: Three Rivers PPO |
$2,002.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,762.20
|
| Rate for Payer: United Healthcare Commercial |
$2,322.90
|
| Rate for Payer: United Healthcare Medicare |
$1,762.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,536.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,536.50
|
|
|
HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
3417830001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$702.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
3417830001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY
|
Facility
|
IP
|
$2,505.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
3417830601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,570.64 |
| Max. Negotiated Rate |
$2,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,454.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,404.80
|
| Rate for Payer: Altius Commercial |
$2,404.80
|
| Rate for Payer: Beech Street Commercial |
$2,454.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,056.60
|
| Rate for Payer: Cash Price |
$1,753.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,429.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,454.90
|
| Rate for Payer: Entrust Commercial |
$2,379.75
|
| Rate for Payer: First Choice Health Commercial |
$2,379.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,379.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,653.30
|
| Rate for Payer: HealthUtah PPO |
$2,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,429.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1,570.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,454.90
|
| Rate for Payer: PacificSource Commercial |
$2,254.50
|
| Rate for Payer: PHCS PPO |
$2,454.90
|
| Rate for Payer: Three Rivers PPO |
$1,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,653.30
|
| Rate for Payer: United Healthcare Commercial |
$2,179.35
|
| Rate for Payer: United Healthcare Medicare |
$1,653.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,379.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,379.75
|
|
|
HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY
|
Facility
|
OP
|
$2,505.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
3417830601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,380.26 |
| Max. Negotiated Rate |
$2,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,454.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,653.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,404.80
|
| Rate for Payer: Altius Commercial |
$2,404.80
|
| Rate for Payer: Beech Street Commercial |
$2,454.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,056.60
|
| Rate for Payer: Cash Price |
$1,753.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,429.85
|
| Rate for Payer: Cigna of WY Commercial |
$2,454.90
|
| Rate for Payer: Entrust Commercial |
$2,379.75
|
| Rate for Payer: First Choice Health Commercial |
$2,379.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,379.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,452.90
|
| Rate for Payer: HealthUtah PPO |
$2,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,429.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1,380.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,454.90
|
| Rate for Payer: PacificSource Commercial |
$2,254.50
|
| Rate for Payer: PHCS PPO |
$2,454.90
|
| Rate for Payer: Three Rivers PPO |
$1,878.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,452.90
|
| Rate for Payer: United Healthcare Commercial |
$2,179.35
|
| Rate for Payer: United Healthcare Medicare |
$1,452.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,454.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,379.75
|
|
|
HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY IGA
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
3028661503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY IGA
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
3028661503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY IGG
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
3028661502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY IGG
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86615
|
| Hospital Charge Code |
3028661502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC BOWEL IMAGING - NM MECKELS DIVERTICULUM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
3417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
