|
HC CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
5102453001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$349.86
|
| Rate for Payer: Aetna of WY Medicare |
$235.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$342.72
|
| Rate for Payer: Altius Commercial |
$342.72
|
| Rate for Payer: Beech Street Commercial |
$349.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.10
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$346.29
|
| Rate for Payer: Cigna of WY Commercial |
$349.86
|
| Rate for Payer: Entrust Commercial |
$339.15
|
| Rate for Payer: First Choice Health Commercial |
$339.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$339.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.06
|
| Rate for Payer: HealthUtah PPO |
$357.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$346.29
|
| Rate for Payer: Multiplan Medicare/VA |
$196.71
|
| Rate for Payer: One Health Plan of WY PPO |
$349.86
|
| Rate for Payer: PacificSource Commercial |
$321.30
|
| Rate for Payer: PHCS PPO |
$349.86
|
| Rate for Payer: Three Rivers PPO |
$267.75
|
| Rate for Payer: TriWest Veterans Administration |
$207.06
|
| Rate for Payer: United Healthcare Commercial |
$310.59
|
| Rate for Payer: United Healthcare Medicare |
$207.06
|
| Rate for Payer: WINHealth Partners Commercial |
$349.86
|
| Rate for Payer: Wise Provider Network Commercial |
$339.15
|
|
|
HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
5102750101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.66 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$502.74
|
| Rate for Payer: Aetna of WY Medicare |
$338.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$492.48
|
| Rate for Payer: Altius Commercial |
$492.48
|
| Rate for Payer: Beech Street Commercial |
$502.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.17
|
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$497.61
|
| Rate for Payer: Cigna of WY Commercial |
$502.74
|
| Rate for Payer: Entrust Commercial |
$487.35
|
| Rate for Payer: First Choice Health Commercial |
$487.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$487.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.54
|
| Rate for Payer: HealthUtah PPO |
$513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$497.61
|
| Rate for Payer: Multiplan Medicare/VA |
$282.66
|
| Rate for Payer: One Health Plan of WY PPO |
$502.74
|
| Rate for Payer: PacificSource Commercial |
$461.70
|
| Rate for Payer: PHCS PPO |
$502.74
|
| Rate for Payer: Three Rivers PPO |
$384.75
|
| Rate for Payer: TriWest Veterans Administration |
$297.54
|
| Rate for Payer: United Healthcare Commercial |
$446.31
|
| Rate for Payer: United Healthcare Medicare |
$297.54
|
| Rate for Payer: WINHealth Partners Commercial |
$502.74
|
| Rate for Payer: Wise Provider Network Commercial |
$487.35
|
|
|
HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
5102750101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.65 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$502.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$492.48
|
| Rate for Payer: Altius Commercial |
$492.48
|
| Rate for Payer: Beech Street Commercial |
$502.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.17
|
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$497.61
|
| Rate for Payer: Cigna of WY Commercial |
$502.74
|
| Rate for Payer: Entrust Commercial |
$487.35
|
| Rate for Payer: First Choice Health Commercial |
$487.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$487.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$338.58
|
| Rate for Payer: HealthUtah PPO |
$513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$497.61
|
| Rate for Payer: Multiplan Medicare/VA |
$321.65
|
| Rate for Payer: One Health Plan of WY PPO |
$502.74
|
| Rate for Payer: PacificSource Commercial |
$461.70
|
| Rate for Payer: PHCS PPO |
$502.74
|
| Rate for Payer: Three Rivers PPO |
$384.75
|
| Rate for Payer: TriWest Veterans Administration |
$338.58
|
| Rate for Payer: United Healthcare Commercial |
$446.31
|
| Rate for Payer: United Healthcare Medicare |
$338.58
|
| Rate for Payer: WINHealth Partners Commercial |
$487.35
|
| Rate for Payer: Wise Provider Network Commercial |
$487.35
|
|
|
HC CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
5102775201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.52 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$497.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$487.68
|
| Rate for Payer: Altius Commercial |
$487.68
|
| Rate for Payer: Beech Street Commercial |
$497.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$417.07
|
| Rate for Payer: Cash Price |
$355.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$492.76
|
| Rate for Payer: Cigna of WY Commercial |
$497.84
|
| Rate for Payer: Entrust Commercial |
$482.60
|
| Rate for Payer: First Choice Health Commercial |
$482.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$482.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$335.28
|
| Rate for Payer: HealthUtah PPO |
$508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$492.76
|
| Rate for Payer: Multiplan Medicare/VA |
$318.52
|
| Rate for Payer: One Health Plan of WY PPO |
$497.84
|
| Rate for Payer: PacificSource Commercial |
$457.20
|
| Rate for Payer: PHCS PPO |
$497.84
|
| Rate for Payer: Three Rivers PPO |
$381.00
|
| Rate for Payer: TriWest Veterans Administration |
$335.28
|
| Rate for Payer: United Healthcare Commercial |
$441.96
|
| Rate for Payer: United Healthcare Medicare |
$335.28
|
| Rate for Payer: WINHealth Partners Commercial |
$482.60
|
| Rate for Payer: Wise Provider Network Commercial |
$482.60
|
|
|
HC CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
5102775201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$279.91 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$497.84
|
| Rate for Payer: Aetna of WY Medicare |
$335.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$487.68
|
| Rate for Payer: Altius Commercial |
$487.68
|
| Rate for Payer: Beech Street Commercial |
$497.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$417.07
|
| Rate for Payer: Cash Price |
$355.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$492.76
|
| Rate for Payer: Cigna of WY Commercial |
$497.84
|
| Rate for Payer: Entrust Commercial |
$482.60
|
| Rate for Payer: First Choice Health Commercial |
$482.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$482.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.64
|
| Rate for Payer: HealthUtah PPO |
$508.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$492.76
|
| Rate for Payer: Multiplan Medicare/VA |
$279.91
|
| Rate for Payer: One Health Plan of WY PPO |
$497.84
|
| Rate for Payer: PacificSource Commercial |
$457.20
|
| Rate for Payer: PHCS PPO |
$497.84
|
| Rate for Payer: Three Rivers PPO |
$381.00
|
| Rate for Payer: TriWest Veterans Administration |
$294.64
|
| Rate for Payer: United Healthcare Commercial |
$441.96
|
| Rate for Payer: United Healthcare Medicare |
$294.64
|
| Rate for Payer: WINHealth Partners Commercial |
$497.84
|
| Rate for Payer: Wise Provider Network Commercial |
$482.60
|
|
|
HC CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
5102568001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.09 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.18
|
| Rate for Payer: Aetna of WY Medicare |
$357.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$519.36
|
| Rate for Payer: Altius Commercial |
$519.36
|
| Rate for Payer: Beech Street Commercial |
$530.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.16
|
| Rate for Payer: Cash Price |
$378.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.77
|
| Rate for Payer: Cigna of WY Commercial |
$530.18
|
| Rate for Payer: Entrust Commercial |
$513.95
|
| Rate for Payer: First Choice Health Commercial |
$513.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.78
|
| Rate for Payer: HealthUtah PPO |
$541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.77
|
| Rate for Payer: Multiplan Medicare/VA |
$298.09
|
| Rate for Payer: One Health Plan of WY PPO |
$530.18
|
| Rate for Payer: PacificSource Commercial |
$486.90
|
| Rate for Payer: PHCS PPO |
$530.18
|
| Rate for Payer: Three Rivers PPO |
$405.75
|
| Rate for Payer: TriWest Veterans Administration |
$313.78
|
| Rate for Payer: United Healthcare Commercial |
$470.67
|
| Rate for Payer: United Healthcare Medicare |
$313.78
|
| Rate for Payer: WINHealth Partners Commercial |
$530.18
|
| Rate for Payer: Wise Provider Network Commercial |
$513.95
|
|
|
HC CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
5102568001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.21 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$519.36
|
| Rate for Payer: Altius Commercial |
$519.36
|
| Rate for Payer: Beech Street Commercial |
$530.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.16
|
| Rate for Payer: Cash Price |
$378.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.77
|
| Rate for Payer: Cigna of WY Commercial |
$530.18
|
| Rate for Payer: Entrust Commercial |
$513.95
|
| Rate for Payer: First Choice Health Commercial |
$513.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$357.06
|
| Rate for Payer: HealthUtah PPO |
$541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.77
|
| Rate for Payer: Multiplan Medicare/VA |
$339.21
|
| Rate for Payer: One Health Plan of WY PPO |
$530.18
|
| Rate for Payer: PacificSource Commercial |
$486.90
|
| Rate for Payer: PHCS PPO |
$530.18
|
| Rate for Payer: Three Rivers PPO |
$405.75
|
| Rate for Payer: TriWest Veterans Administration |
$357.06
|
| Rate for Payer: United Healthcare Commercial |
$470.67
|
| Rate for Payer: United Healthcare Medicare |
$357.06
|
| Rate for Payer: WINHealth Partners Commercial |
$513.95
|
| Rate for Payer: Wise Provider Network Commercial |
$513.95
|
|
|
HC CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
5102781801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.96
|
| Rate for Payer: Altius Commercial |
$336.96
|
| Rate for Payer: Beech Street Commercial |
$343.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$288.17
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$340.47
|
| Rate for Payer: Cigna of WY Commercial |
$343.98
|
| Rate for Payer: Entrust Commercial |
$333.45
|
| Rate for Payer: First Choice Health Commercial |
$333.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$333.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.66
|
| Rate for Payer: HealthUtah PPO |
$351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$340.47
|
| Rate for Payer: Multiplan Medicare/VA |
$220.08
|
| Rate for Payer: One Health Plan of WY PPO |
$343.98
|
| Rate for Payer: PacificSource Commercial |
$315.90
|
| Rate for Payer: PHCS PPO |
$343.98
|
| Rate for Payer: Three Rivers PPO |
$263.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.66
|
| Rate for Payer: United Healthcare Commercial |
$305.37
|
| Rate for Payer: United Healthcare Medicare |
$231.66
|
| Rate for Payer: WINHealth Partners Commercial |
$333.45
|
| Rate for Payer: Wise Provider Network Commercial |
$333.45
|
|
|
HC CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
5102781801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.40 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.98
|
| Rate for Payer: Aetna of WY Medicare |
$231.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.96
|
| Rate for Payer: Altius Commercial |
$336.96
|
| Rate for Payer: Beech Street Commercial |
$343.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$288.17
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$340.47
|
| Rate for Payer: Cigna of WY Commercial |
$343.98
|
| Rate for Payer: Entrust Commercial |
$333.45
|
| Rate for Payer: First Choice Health Commercial |
$333.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$333.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.58
|
| Rate for Payer: HealthUtah PPO |
$351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$340.47
|
| Rate for Payer: Multiplan Medicare/VA |
$193.40
|
| Rate for Payer: One Health Plan of WY PPO |
$343.98
|
| Rate for Payer: PacificSource Commercial |
$315.90
|
| Rate for Payer: PHCS PPO |
$343.98
|
| Rate for Payer: Three Rivers PPO |
$263.25
|
| Rate for Payer: TriWest Veterans Administration |
$203.58
|
| Rate for Payer: United Healthcare Commercial |
$305.37
|
| Rate for Payer: United Healthcare Medicare |
$203.58
|
| Rate for Payer: WINHealth Partners Commercial |
$343.98
|
| Rate for Payer: Wise Provider Network Commercial |
$333.45
|
|
|
HC CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
5102231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
5102231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CMV ANTIBODY - CYTOMEGALOVIRUS IGG
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3028664401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC CMV ANTIBODY - CYTOMEGALOVIRUS IGG
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3028664401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 86645 90
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 86645 90
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CNTRL NASAL HEMORRHA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
7613090601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CNTRL NASAL HEMORRHA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
7613090601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CNTRL OROPHARYNGEAL HEM
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
7614296201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CNTRL OROPHARYNGEAL HEM
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
7614296201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.30 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$165.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.96
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$206.07
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.58
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$138.30
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$145.58
|
| Rate for Payer: United Healthcare Commercial |
$218.37
|
| Rate for Payer: United Healthcare Medicare |
$145.58
|
| Rate for Payer: WINHealth Partners Commercial |
$245.98
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.96
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$206.07
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.66
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$157.38
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$218.37
|
| Rate for Payer: United Healthcare Medicare |
$165.66
|
| Rate for Payer: WINHealth Partners Commercial |
$238.45
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
