|
HC CAMS TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90714 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369071401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC CAMS TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
6369071401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.96
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.66
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$63.33
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.66
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$66.66
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC CAMS TRIAMCINOLONE ACETONIDE INJ
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Aetna of WY Medicare |
$4.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.72
|
| Rate for Payer: Altius Commercial |
$6.72
|
| Rate for Payer: Beech Street Commercial |
$6.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: Entrust Commercial |
$6.65
|
| Rate for Payer: First Choice Health Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.06
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$3.86
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.86
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$4.06
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$4.06
|
| Rate for Payer: WINHealth Partners Commercial |
$6.86
|
| Rate for Payer: Wise Provider Network Commercial |
$6.65
|
|
|
HC CAMS TRIAMCINOLONE ACETONIDE INJ
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.72
|
| Rate for Payer: Altius Commercial |
$6.72
|
| Rate for Payer: Beech Street Commercial |
$6.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.75
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: Entrust Commercial |
$6.65
|
| Rate for Payer: First Choice Health Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.62
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$4.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.86
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$4.62
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$4.62
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
| Rate for Payer: Wise Provider Network Commercial |
$6.65
|
|
|
HC CAMS VITAMIN B12 INJECTION
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Aetna of WY Medicare |
$19.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.84
|
| Rate for Payer: Altius Commercial |
$27.84
|
| Rate for Payer: Beech Street Commercial |
$28.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: Entrust Commercial |
$27.55
|
| Rate for Payer: First Choice Health Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.82
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$15.98
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$28.42
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.82
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$16.82
|
| Rate for Payer: WINHealth Partners Commercial |
$28.42
|
| Rate for Payer: Wise Provider Network Commercial |
$27.55
|
|
|
HC CAMS VITAMIN B12 INJECTION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.84
|
| Rate for Payer: Altius Commercial |
$27.84
|
| Rate for Payer: Beech Street Commercial |
$28.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: Entrust Commercial |
$27.55
|
| Rate for Payer: First Choice Health Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$28.42
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$27.55
|
| Rate for Payer: Wise Provider Network Commercial |
$27.55
|
|
|
HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86628
|
| Hospital Charge Code |
3028662801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86628
|
| Hospital Charge Code |
3028662801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
3068748001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
3068748001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| 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 CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| 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 CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
OP
|
$2,780.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,531.78 |
| Max. Negotiated Rate |
$2,780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,724.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,834.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,668.80
|
| Rate for Payer: Altius Commercial |
$2,668.80
|
| Rate for Payer: Beech Street Commercial |
$2,724.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,282.38
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,696.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,724.40
|
| Rate for Payer: Entrust Commercial |
$2,641.00
|
| Rate for Payer: First Choice Health Commercial |
$2,641.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,641.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,612.40
|
| Rate for Payer: HealthUtah PPO |
$2,780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,696.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,531.78
|
| Rate for Payer: One Health Plan of WY PPO |
$2,724.40
|
| Rate for Payer: PacificSource Commercial |
$2,502.00
|
| Rate for Payer: PHCS PPO |
$2,724.40
|
| Rate for Payer: Three Rivers PPO |
$2,085.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,612.40
|
| Rate for Payer: United Healthcare Commercial |
$2,418.60
|
| Rate for Payer: United Healthcare Medicare |
$1,612.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,724.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,641.00
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
IP
|
$2,780.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,743.06 |
| Max. Negotiated Rate |
$2,780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,724.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,668.80
|
| Rate for Payer: Altius Commercial |
$2,668.80
|
| Rate for Payer: Beech Street Commercial |
$2,724.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,282.38
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,696.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,724.40
|
| Rate for Payer: Entrust Commercial |
$2,641.00
|
| Rate for Payer: First Choice Health Commercial |
$2,641.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,641.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,834.80
|
| Rate for Payer: HealthUtah PPO |
$2,780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,696.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,743.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,724.40
|
| Rate for Payer: PacificSource Commercial |
$2,502.00
|
| Rate for Payer: PHCS PPO |
$2,724.40
|
| Rate for Payer: Three Rivers PPO |
$2,085.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,834.80
|
| Rate for Payer: United Healthcare Commercial |
$2,418.60
|
| Rate for Payer: United Healthcare Medicare |
$1,834.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,641.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,641.00
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$912.28 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$960.30
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$912.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$960.30
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$960.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,382.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$801.70 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Aetna of WY Medicare |
$960.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.90
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$801.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.90
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$843.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$801.70 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Aetna of WY Medicare |
$960.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.90
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$801.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.90
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$843.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$912.28 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$960.30
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$912.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$960.30
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$960.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,382.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
