|
HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 82107
|
| Hospital Charge Code |
3018210701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$331.52
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.98
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$300.18
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$315.98
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$315.98
|
| Rate for Payer: WINHealth Partners Commercial |
$492.10
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 82107
|
| Hospital Charge Code |
3018210701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$341.88
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.26
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$280.50
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.26
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$295.26
|
| Rate for Payer: WINHealth Partners Commercial |
$507.64
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$107.58
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.91
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.91
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$92.91
|
| Rate for Payer: WINHealth Partners Commercial |
$159.74
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$104.32
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.43
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$94.46
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.43
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$99.43
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$92.80
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.45
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$84.03
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$88.45
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA-FETOPROTEIN MARKER
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$78.52
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.65
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$82.65
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$104.32
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.43
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$94.46
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.43
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$99.43
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ALPHA-FETOPROTEIN, SERUM - ALPHA FETOPROTEIN, MATERNAL
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$107.58
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.91
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.91
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$92.91
|
| Rate for Payer: WINHealth Partners Commercial |
$159.74
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ALS LEVEL 2
|
Facility
|
IP
|
$4,254.00
|
|
|
Service Code
|
HCPCS A0433
|
| Hospital Charge Code |
540A043301
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$2,465.19 |
| Max. Negotiated Rate |
$4,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,168.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,722.56
|
| Rate for Payer: Altius Commercial |
$4,083.84
|
| Rate for Payer: Beech Street Commercial |
$4,168.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,126.38
|
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,126.38
|
| Rate for Payer: Cigna of WY Commercial |
$4,168.92
|
| Rate for Payer: Entrust Commercial |
$4,041.30
|
| Rate for Payer: First Choice Health Commercial |
$4,041.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,041.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,594.94
|
| Rate for Payer: HealthUtah PPO |
$4,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,126.38
|
| Rate for Payer: Multiplan Medicare/VA |
$2,465.19
|
| Rate for Payer: One Health Plan of WY PPO |
$4,168.92
|
| Rate for Payer: PacificSource Commercial |
$3,828.60
|
| Rate for Payer: PHCS PPO |
$4,168.92
|
| Rate for Payer: Three Rivers PPO |
$3,190.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,594.94
|
| Rate for Payer: United Healthcare Commercial |
$4,062.57
|
| Rate for Payer: United Healthcare Medicare |
$2,594.94
|
| Rate for Payer: WINHealth Partners Commercial |
$4,041.30
|
| Rate for Payer: Wise Provider Network Commercial |
$4,041.30
|
|
|
HC ALS LEVEL 2
|
Facility
|
OP
|
$4,254.00
|
|
|
Service Code
|
HCPCS A0433
|
| Hospital Charge Code |
540A043301
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$2,303.54 |
| Max. Negotiated Rate |
$4,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,168.92
|
| Rate for Payer: Aetna of WY Medicare |
$2,807.64
|
| Rate for Payer: Altius Commercial |
$4,083.84
|
| Rate for Payer: Beech Street Commercial |
$4,168.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,126.38
|
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,126.38
|
| Rate for Payer: Cigna of WY Commercial |
$4,168.92
|
| Rate for Payer: Entrust Commercial |
$4,041.30
|
| Rate for Payer: First Choice Health Commercial |
$4,041.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,041.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,424.78
|
| Rate for Payer: HealthUtah PPO |
$4,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,126.38
|
| Rate for Payer: Multiplan Medicare/VA |
$2,303.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,168.92
|
| Rate for Payer: PacificSource Commercial |
$3,828.60
|
| Rate for Payer: PHCS PPO |
$4,168.92
|
| Rate for Payer: Three Rivers PPO |
$3,190.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,424.78
|
| Rate for Payer: United Healthcare Commercial |
$4,062.57
|
| Rate for Payer: United Healthcare Medicare |
$2,424.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,168.92
|
| Rate for Payer: Wise Provider Network Commercial |
$4,041.30
|
|
|
HC AMBULANCE EMERGENT ALS 1
|
Facility
|
IP
|
$3,376.00
|
|
|
Service Code
|
HCPCS A0427
|
| Hospital Charge Code |
540A042701
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,956.39 |
| Max. Negotiated Rate |
$3,376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,308.48
|
| Rate for Payer: Aetna of WY Medicare |
$2,160.64
|
| Rate for Payer: Altius Commercial |
$3,240.96
|
| Rate for Payer: Beech Street Commercial |
$3,308.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,274.72
|
| Rate for Payer: Cash Price |
$2,363.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,274.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,308.48
|
| Rate for Payer: Entrust Commercial |
$3,207.20
|
| Rate for Payer: First Choice Health Commercial |
$3,207.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,207.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,059.36
|
| Rate for Payer: HealthUtah PPO |
$3,376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,274.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1,956.39
|
| Rate for Payer: One Health Plan of WY PPO |
$3,308.48
|
| Rate for Payer: PacificSource Commercial |
$3,038.40
|
| Rate for Payer: PHCS PPO |
$3,308.48
|
| Rate for Payer: Three Rivers PPO |
$2,532.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,059.36
|
| Rate for Payer: United Healthcare Commercial |
$3,224.08
|
| Rate for Payer: United Healthcare Medicare |
$2,059.36
|
| Rate for Payer: WINHealth Partners Commercial |
$3,207.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,207.20
|
|
|
HC AMBULANCE EMERGENT ALS 1
|
Facility
|
OP
|
$3,376.00
|
|
|
Service Code
|
HCPCS A0427
|
| Hospital Charge Code |
540A042701
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,828.10 |
| Max. Negotiated Rate |
$3,376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,308.48
|
| Rate for Payer: Aetna of WY Medicare |
$2,228.16
|
| Rate for Payer: Altius Commercial |
$3,240.96
|
| Rate for Payer: Beech Street Commercial |
$3,308.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,274.72
|
| Rate for Payer: Cash Price |
$2,363.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,274.72
|
| Rate for Payer: Cigna of WY Commercial |
$3,308.48
|
| Rate for Payer: Entrust Commercial |
$3,207.20
|
| Rate for Payer: First Choice Health Commercial |
$3,207.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,207.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,924.32
|
| Rate for Payer: HealthUtah PPO |
$3,376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,274.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1,828.10
|
| Rate for Payer: One Health Plan of WY PPO |
$3,308.48
|
| Rate for Payer: PacificSource Commercial |
$3,038.40
|
| Rate for Payer: PHCS PPO |
$3,308.48
|
| Rate for Payer: Three Rivers PPO |
$2,532.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,924.32
|
| Rate for Payer: United Healthcare Commercial |
$3,224.08
|
| Rate for Payer: United Healthcare Medicare |
$1,924.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,308.48
|
| Rate for Payer: Wise Provider Network Commercial |
$3,207.20
|
|
|
HC AMBULANCE EMERGENT BLS
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS A0429
|
| Hospital Charge Code |
540A042901
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,359.71 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,460.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,657.26
|
| Rate for Payer: Altius Commercial |
$2,410.56
|
| Rate for Payer: Beech Street Commercial |
$2,460.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,435.67
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,435.67
|
| Rate for Payer: Cigna of WY Commercial |
$2,460.78
|
| Rate for Payer: Entrust Commercial |
$2,385.45
|
| Rate for Payer: First Choice Health Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,431.27
|
| Rate for Payer: HealthUtah PPO |
$2,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,435.67
|
| Rate for Payer: Multiplan Medicare/VA |
$1,359.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,460.78
|
| Rate for Payer: PacificSource Commercial |
$2,259.90
|
| Rate for Payer: PHCS PPO |
$2,460.78
|
| Rate for Payer: Three Rivers PPO |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,431.27
|
| Rate for Payer: United Healthcare Commercial |
$2,398.00
|
| Rate for Payer: United Healthcare Medicare |
$1,431.27
|
| Rate for Payer: WINHealth Partners Commercial |
$2,460.78
|
| Rate for Payer: Wise Provider Network Commercial |
$2,385.45
|
|
|
HC AMBULANCE EMERGENT BLS
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS A0429
|
| Hospital Charge Code |
540A042901
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,455.12 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,460.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,607.04
|
| Rate for Payer: Altius Commercial |
$2,410.56
|
| Rate for Payer: Beech Street Commercial |
$2,460.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,435.67
|
| Rate for Payer: Cash Price |
$1,757.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,435.67
|
| Rate for Payer: Cigna of WY Commercial |
$2,460.78
|
| Rate for Payer: Entrust Commercial |
$2,385.45
|
| Rate for Payer: First Choice Health Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,385.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,531.71
|
| Rate for Payer: HealthUtah PPO |
$2,511.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,435.67
|
| Rate for Payer: Multiplan Medicare/VA |
$1,455.12
|
| Rate for Payer: One Health Plan of WY PPO |
$2,460.78
|
| Rate for Payer: PacificSource Commercial |
$2,259.90
|
| Rate for Payer: PHCS PPO |
$2,460.78
|
| Rate for Payer: Three Rivers PPO |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,531.71
|
| Rate for Payer: United Healthcare Commercial |
$2,398.00
|
| Rate for Payer: United Healthcare Medicare |
$1,531.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2,385.45
|
| Rate for Payer: Wise Provider Network Commercial |
$2,385.45
|
|
|
HC AMBULANCE NON EMERGENT ALS 1
|
Facility
|
IP
|
$2,704.00
|
|
|
Service Code
|
HCPCS A0426
|
| Hospital Charge Code |
540A042601
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,566.97 |
| Max. Negotiated Rate |
$2,704.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,649.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,730.56
|
| Rate for Payer: Altius Commercial |
$2,595.84
|
| Rate for Payer: Beech Street Commercial |
$2,649.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,622.88
|
| Rate for Payer: Cash Price |
$1,892.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,622.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,649.92
|
| Rate for Payer: Entrust Commercial |
$2,568.80
|
| Rate for Payer: First Choice Health Commercial |
$2,568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,649.44
|
| Rate for Payer: HealthUtah PPO |
$2,704.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,622.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,566.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,649.92
|
| Rate for Payer: PacificSource Commercial |
$2,433.60
|
| Rate for Payer: PHCS PPO |
$2,649.92
|
| Rate for Payer: Three Rivers PPO |
$2,028.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,649.44
|
| Rate for Payer: United Healthcare Commercial |
$2,582.32
|
| Rate for Payer: United Healthcare Medicare |
$1,649.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,568.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,568.80
|
|
|
HC AMBULANCE NON EMERGENT ALS 1
|
Facility
|
OP
|
$2,704.00
|
|
|
Service Code
|
HCPCS A0426
|
| Hospital Charge Code |
540A042601
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,464.22 |
| Max. Negotiated Rate |
$2,704.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,649.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,784.64
|
| Rate for Payer: Altius Commercial |
$2,595.84
|
| Rate for Payer: Beech Street Commercial |
$2,649.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,622.88
|
| Rate for Payer: Cash Price |
$1,892.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,622.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,649.92
|
| Rate for Payer: Entrust Commercial |
$2,568.80
|
| Rate for Payer: First Choice Health Commercial |
$2,568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,568.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,541.28
|
| Rate for Payer: HealthUtah PPO |
$2,704.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,622.88
|
| Rate for Payer: Multiplan Medicare/VA |
$1,464.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,649.92
|
| Rate for Payer: PacificSource Commercial |
$2,433.60
|
| Rate for Payer: PHCS PPO |
$2,649.92
|
| Rate for Payer: Three Rivers PPO |
$2,028.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,541.28
|
| Rate for Payer: United Healthcare Commercial |
$2,582.32
|
| Rate for Payer: United Healthcare Medicare |
$1,541.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2,649.92
|
| Rate for Payer: Wise Provider Network Commercial |
$2,568.80
|
|
|
HC AMBULANCE NON EMERGENT BLS
|
Facility
|
IP
|
$1,881.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
540A042801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,090.04 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,843.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,203.84
|
| Rate for Payer: Altius Commercial |
$1,805.76
|
| Rate for Payer: Beech Street Commercial |
$1,843.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,824.57
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,824.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,843.38
|
| Rate for Payer: Entrust Commercial |
$1,786.95
|
| Rate for Payer: First Choice Health Commercial |
$1,786.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,786.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,147.41
|
| Rate for Payer: HealthUtah PPO |
$1,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,824.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,090.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,843.38
|
| Rate for Payer: PacificSource Commercial |
$1,692.90
|
| Rate for Payer: PHCS PPO |
$1,843.38
|
| Rate for Payer: Three Rivers PPO |
$1,410.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,147.41
|
| Rate for Payer: United Healthcare Commercial |
$1,796.36
|
| Rate for Payer: United Healthcare Medicare |
$1,147.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,786.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,786.95
|
|
|
HC AMBULANCE NON EMERGENT BLS
|
Facility
|
OP
|
$1,881.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
540A042801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,018.56 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,843.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,241.46
|
| Rate for Payer: Altius Commercial |
$1,805.76
|
| Rate for Payer: Beech Street Commercial |
$1,843.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,824.57
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,824.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,843.38
|
| Rate for Payer: Entrust Commercial |
$1,786.95
|
| Rate for Payer: First Choice Health Commercial |
$1,786.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,786.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,072.17
|
| Rate for Payer: HealthUtah PPO |
$1,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,824.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,018.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,843.38
|
| Rate for Payer: PacificSource Commercial |
$1,692.90
|
| Rate for Payer: PHCS PPO |
$1,843.38
|
| Rate for Payer: Three Rivers PPO |
$1,410.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,072.17
|
| Rate for Payer: United Healthcare Commercial |
$1,796.36
|
| Rate for Payer: United Healthcare Medicare |
$1,072.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1,843.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,786.95
|
|
|
HC AMBULANCE RESPONSE W TX NO TRANSPORT
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
HCPCS A0998
|
| Hospital Charge Code |
540A099801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$580.66 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$981.96
|
| Rate for Payer: Aetna of WY Medicare |
$641.28
|
| Rate for Payer: Altius Commercial |
$961.92
|
| Rate for Payer: Beech Street Commercial |
$981.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$971.94
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$971.94
|
| Rate for Payer: Cigna of WY Commercial |
$981.96
|
| Rate for Payer: Entrust Commercial |
$951.90
|
| Rate for Payer: First Choice Health Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$611.22
|
| Rate for Payer: HealthUtah PPO |
$1,002.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$971.94
|
| Rate for Payer: Multiplan Medicare/VA |
$580.66
|
| Rate for Payer: One Health Plan of WY PPO |
$981.96
|
| Rate for Payer: PacificSource Commercial |
$901.80
|
| Rate for Payer: PHCS PPO |
$981.96
|
| Rate for Payer: Three Rivers PPO |
$751.50
|
| Rate for Payer: TriWest Veterans Administration |
$611.22
|
| Rate for Payer: United Healthcare Commercial |
$956.91
|
| Rate for Payer: United Healthcare Medicare |
$611.22
|
| Rate for Payer: WINHealth Partners Commercial |
$951.90
|
| Rate for Payer: Wise Provider Network Commercial |
$951.90
|
|
|
HC AMBULANCE RESPONSE W TX NO TRANSPORT
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
HCPCS A0998
|
| Hospital Charge Code |
540A099801
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$542.58 |
| Max. Negotiated Rate |
$1,002.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$981.96
|
| Rate for Payer: Aetna of WY Medicare |
$661.32
|
| Rate for Payer: Altius Commercial |
$961.92
|
| Rate for Payer: Beech Street Commercial |
$981.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$971.94
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$971.94
|
| Rate for Payer: Cigna of WY Commercial |
$981.96
|
| Rate for Payer: Entrust Commercial |
$951.90
|
| Rate for Payer: First Choice Health Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$951.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$571.14
|
| Rate for Payer: HealthUtah PPO |
$1,002.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$971.94
|
| Rate for Payer: Multiplan Medicare/VA |
$542.58
|
| Rate for Payer: One Health Plan of WY PPO |
$981.96
|
| Rate for Payer: PacificSource Commercial |
$901.80
|
| Rate for Payer: PHCS PPO |
$981.96
|
| Rate for Payer: Three Rivers PPO |
$751.50
|
| Rate for Payer: TriWest Veterans Administration |
$571.14
|
| Rate for Payer: United Healthcare Commercial |
$956.91
|
| Rate for Payer: United Healthcare Medicare |
$571.14
|
| Rate for Payer: WINHealth Partners Commercial |
$981.96
|
| Rate for Payer: Wise Provider Network Commercial |
$951.90
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
3018213901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$127.36
|
| Rate for Payer: Altius Commercial |
$191.04
|
| Rate for Payer: Beech Street Commercial |
$195.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.03
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: Entrust Commercial |
$189.05
|
| Rate for Payer: First Choice Health Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.39
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$115.32
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$195.02
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$121.39
|
| Rate for Payer: United Healthcare Commercial |
$190.04
|
| Rate for Payer: United Healthcare Medicare |
$121.39
|
| Rate for Payer: WINHealth Partners Commercial |
$189.05
|
| Rate for Payer: Wise Provider Network Commercial |
$189.05
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$131.34
|
| Rate for Payer: Altius Commercial |
$191.04
|
| Rate for Payer: Beech Street Commercial |
$195.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.03
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: Entrust Commercial |
$189.05
|
| Rate for Payer: First Choice Health Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.43
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$107.76
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$195.02
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.43
|
| Rate for Payer: United Healthcare Commercial |
$190.04
|
| Rate for Payer: United Healthcare Medicare |
$113.43
|
| Rate for Payer: WINHealth Partners Commercial |
$195.02
|
| Rate for Payer: Wise Provider Network Commercial |
$189.05
|
|
|
HC AMINO ACIDS, SINGLE QUANTITATION - TRYPTOPHAN PLASMA
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
3018213102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$199.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$195.02
|
| Rate for Payer: Aetna of WY Medicare |
$131.34
|
| Rate for Payer: Altius Commercial |
$191.04
|
| Rate for Payer: Beech Street Commercial |
$195.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.03
|
| Rate for Payer: Cash Price |
$139.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$193.03
|
| Rate for Payer: Cigna of WY Commercial |
$195.02
|
| Rate for Payer: Entrust Commercial |
$189.05
|
| Rate for Payer: First Choice Health Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$189.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.43
|
| Rate for Payer: HealthUtah PPO |
$199.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$193.03
|
| Rate for Payer: Multiplan Medicare/VA |
$107.76
|
| Rate for Payer: One Health Plan of WY PPO |
$195.02
|
| Rate for Payer: PacificSource Commercial |
$179.10
|
| Rate for Payer: PHCS PPO |
$195.02
|
| Rate for Payer: Three Rivers PPO |
$149.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.43
|
| Rate for Payer: United Healthcare Commercial |
$190.04
|
| Rate for Payer: United Healthcare Medicare |
$113.43
|
| Rate for Payer: WINHealth Partners Commercial |
$195.02
|
| Rate for Payer: Wise Provider Network Commercial |
$189.05
|
|
