|
HC ANTEPARTUM CARE ONLY 7/> VISITS
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
5105942601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.74 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$280.28
|
| Rate for Payer: Aetna of WY Medicare |
$183.04
|
| Rate for Payer: Altius Commercial |
$274.56
|
| Rate for Payer: Beech Street Commercial |
$280.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$277.42
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$277.42
|
| Rate for Payer: Cigna of WY Commercial |
$280.28
|
| Rate for Payer: Entrust Commercial |
$271.70
|
| Rate for Payer: First Choice Health Commercial |
$271.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$271.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.46
|
| Rate for Payer: HealthUtah PPO |
$286.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$277.42
|
| Rate for Payer: Multiplan Medicare/VA |
$165.74
|
| Rate for Payer: One Health Plan of WY PPO |
$280.28
|
| Rate for Payer: PacificSource Commercial |
$257.40
|
| Rate for Payer: PHCS PPO |
$280.28
|
| Rate for Payer: Three Rivers PPO |
$214.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.46
|
| Rate for Payer: United Healthcare Commercial |
$273.13
|
| Rate for Payer: United Healthcare Medicare |
$174.46
|
| Rate for Payer: WINHealth Partners Commercial |
$271.70
|
| Rate for Payer: Wise Provider Network Commercial |
$271.70
|
|
|
HC ANTEPARTUM CARE ONLY 7/> VISITS
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
5105942601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.87 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$280.28
|
| Rate for Payer: Aetna of WY Medicare |
$188.76
|
| Rate for Payer: Altius Commercial |
$274.56
|
| Rate for Payer: Beech Street Commercial |
$280.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$277.42
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$277.42
|
| Rate for Payer: Cigna of WY Commercial |
$280.28
|
| Rate for Payer: Entrust Commercial |
$271.70
|
| Rate for Payer: First Choice Health Commercial |
$271.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$271.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.02
|
| Rate for Payer: HealthUtah PPO |
$1,137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$277.42
|
| Rate for Payer: Multiplan Medicare/VA |
$154.87
|
| Rate for Payer: One Health Plan of WY PPO |
$280.28
|
| Rate for Payer: PacificSource Commercial |
$257.40
|
| Rate for Payer: PHCS PPO |
$280.28
|
| Rate for Payer: Three Rivers PPO |
$214.50
|
| Rate for Payer: TriWest Veterans Administration |
$163.02
|
| Rate for Payer: United Healthcare Commercial |
$273.13
|
| Rate for Payer: United Healthcare Medicare |
$163.02
|
| Rate for Payer: WINHealth Partners Commercial |
$280.28
|
| Rate for Payer: Wise Provider Network Commercial |
$271.70
|
|
|
HC ANTI A TITER IGG
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$98.56
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.94
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.24
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.94
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$93.94
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI A TITER IGG
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI A TITER IGM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI A TITER IGM
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$98.56
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.94
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.24
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.94
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$93.94
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTBILITY DISK
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$65.28
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.94
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.22
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$59.11
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.22
|
| Rate for Payer: United Healthcare Commercial |
$97.41
|
| Rate for Payer: United Healthcare Medicare |
$62.22
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTBILITY DISK
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.23 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$67.32
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.94
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.14
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$55.23
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.14
|
| Rate for Payer: United Healthcare Commercial |
$97.41
|
| Rate for Payer: United Healthcare Medicare |
$58.14
|
| Rate for Payer: WINHealth Partners Commercial |
$99.96
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SUSCEPTIBILITY
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$122.88
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.12
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$111.26
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.12
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$117.12
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SUSCEPTIBILITY
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$126.72
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.44
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$103.97
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.44
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$109.44
|
| Rate for Payer: WINHealth Partners Commercial |
$188.16
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
3028678001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.16 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$126.08
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.09
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.17
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$114.16
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$120.17
|
| Rate for Payer: United Healthcare Commercial |
$188.14
|
| Rate for Payer: United Healthcare Medicare |
$120.17
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC ANTIBODY TREPONEMA PALLIDUM - T. PALLIDUM CONFIRMATORY
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
3028678001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.68 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.09
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.29
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$106.68
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$112.29
|
| Rate for Payer: United Healthcare Commercial |
$188.14
|
| Rate for Payer: United Healthcare Medicare |
$112.29
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC ANTI B TITER IGG
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$98.56
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.94
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.24
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.94
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$93.94
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI B TITER IGG
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI B TITER IGM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTI B TITER IGM
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
3008694104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$98.56
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.94
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.24
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.94
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$93.94
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - AMITRIPTYLINE LVL
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$133.32
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.14
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$109.38
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.14
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$115.14
|
| Rate for Payer: WINHealth Partners Commercial |
$197.96
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - AMITRIPTYLINE LVL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$129.28
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.22
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$117.06
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$123.22
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$123.22
|
| Rate for Payer: WINHealth Partners Commercial |
$191.90
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - DESIPRAMINE LVL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$129.28
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.22
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$117.06
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$123.22
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$123.22
|
| Rate for Payer: WINHealth Partners Commercial |
$191.90
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - DESIPRAMINE LVL
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$133.32
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.14
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$109.38
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.14
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$115.14
|
| Rate for Payer: WINHealth Partners Commercial |
$197.96
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - IMIPRAMINE LEVEL
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$133.32
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.14
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$109.38
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.14
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$115.14
|
| Rate for Payer: WINHealth Partners Commercial |
$197.96
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - IMIPRAMINE LEVEL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$129.28
|
| Rate for Payer: Altius Commercial |
$193.92
|
| Rate for Payer: Beech Street Commercial |
$197.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$195.94
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Entrust Commercial |
$191.90
|
| Rate for Payer: First Choice Health Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.22
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$117.06
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$197.96
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$123.22
|
| Rate for Payer: United Healthcare Commercial |
$192.91
|
| Rate for Payer: United Healthcare Medicare |
$123.22
|
| Rate for Payer: WINHealth Partners Commercial |
$191.90
|
| Rate for Payer: Wise Provider Network Commercial |
$191.90
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - NORTRIPTYLINE LVL
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.72
|
| Rate for Payer: Aetna of WY Medicare |
$136.96
|
| Rate for Payer: Altius Commercial |
$205.44
|
| Rate for Payer: Beech Street Commercial |
$209.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$207.58
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.58
|
| Rate for Payer: Cigna of WY Commercial |
$209.72
|
| Rate for Payer: Entrust Commercial |
$203.30
|
| Rate for Payer: First Choice Health Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.54
|
| Rate for Payer: HealthUtah PPO |
$214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.58
|
| Rate for Payer: Multiplan Medicare/VA |
$124.01
|
| Rate for Payer: One Health Plan of WY PPO |
$209.72
|
| Rate for Payer: PacificSource Commercial |
$192.60
|
| Rate for Payer: PHCS PPO |
$209.72
|
| Rate for Payer: Three Rivers PPO |
$160.50
|
| Rate for Payer: TriWest Veterans Administration |
$130.54
|
| Rate for Payer: United Healthcare Commercial |
$204.37
|
| Rate for Payer: United Healthcare Medicare |
$130.54
|
| Rate for Payer: WINHealth Partners Commercial |
$203.30
|
| Rate for Payer: Wise Provider Network Commercial |
$203.30
|
|
|
HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - NORTRIPTYLINE LVL
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
3018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.88 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.72
|
| Rate for Payer: Aetna of WY Medicare |
$141.24
|
| Rate for Payer: Altius Commercial |
$205.44
|
| Rate for Payer: Beech Street Commercial |
$209.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$207.58
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.58
|
| Rate for Payer: Cigna of WY Commercial |
$209.72
|
| Rate for Payer: Entrust Commercial |
$203.30
|
| Rate for Payer: First Choice Health Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.98
|
| Rate for Payer: HealthUtah PPO |
$214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.58
|
| Rate for Payer: Multiplan Medicare/VA |
$115.88
|
| Rate for Payer: One Health Plan of WY PPO |
$209.72
|
| Rate for Payer: PacificSource Commercial |
$192.60
|
| Rate for Payer: PHCS PPO |
$209.72
|
| Rate for Payer: Three Rivers PPO |
$160.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.98
|
| Rate for Payer: United Healthcare Commercial |
$204.37
|
| Rate for Payer: United Healthcare Medicare |
$121.98
|
| Rate for Payer: WINHealth Partners Commercial |
$209.72
|
| Rate for Payer: Wise Provider Network Commercial |
$203.30
|
|
|
HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - DIRECT ANTIGLOBULIN TEST
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
3008688002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$101.12
|
| Rate for Payer: Altius Commercial |
$151.68
|
| Rate for Payer: Beech Street Commercial |
$154.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.26
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: Entrust Commercial |
$150.10
|
| Rate for Payer: First Choice Health Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.38
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$91.56
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$154.84
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.38
|
| Rate for Payer: United Healthcare Commercial |
$150.89
|
| Rate for Payer: United Healthcare Medicare |
$96.38
|
| Rate for Payer: WINHealth Partners Commercial |
$150.10
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
