|
HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - DIRECT ANTIGLOBULIN TEST
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
3008688002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.56 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$104.28
|
| 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 |
$90.06
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$85.56
|
| 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 |
$90.06
|
| Rate for Payer: United Healthcare Commercial |
$150.89
|
| Rate for Payer: United Healthcare Medicare |
$90.06
|
| Rate for Payer: WINHealth Partners Commercial |
$154.84
|
| Rate for Payer: Wise Provider Network Commercial |
$150.10
|
|
|
HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
3008688601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$509.01 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$921.20
|
| Rate for Payer: Aetna of WY Medicare |
$620.40
|
| Rate for Payer: Altius Commercial |
$902.40
|
| Rate for Payer: Beech Street Commercial |
$921.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.80
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$911.80
|
| Rate for Payer: Cigna of WY Commercial |
$921.20
|
| Rate for Payer: Entrust Commercial |
$893.00
|
| Rate for Payer: First Choice Health Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$535.80
|
| Rate for Payer: HealthUtah PPO |
$940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$911.80
|
| Rate for Payer: Multiplan Medicare/VA |
$509.01
|
| Rate for Payer: One Health Plan of WY PPO |
$921.20
|
| Rate for Payer: PacificSource Commercial |
$846.00
|
| Rate for Payer: PHCS PPO |
$921.20
|
| Rate for Payer: Three Rivers PPO |
$705.00
|
| Rate for Payer: TriWest Veterans Administration |
$535.80
|
| Rate for Payer: United Healthcare Commercial |
$897.70
|
| Rate for Payer: United Healthcare Medicare |
$535.80
|
| Rate for Payer: WINHealth Partners Commercial |
$921.20
|
| Rate for Payer: Wise Provider Network Commercial |
$893.00
|
|
|
HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
3008688601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$544.73 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$921.20
|
| Rate for Payer: Aetna of WY Medicare |
$601.60
|
| Rate for Payer: Altius Commercial |
$902.40
|
| Rate for Payer: Beech Street Commercial |
$921.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.80
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$911.80
|
| Rate for Payer: Cigna of WY Commercial |
$921.20
|
| Rate for Payer: Entrust Commercial |
$893.00
|
| Rate for Payer: First Choice Health Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$573.40
|
| Rate for Payer: HealthUtah PPO |
$940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$911.80
|
| Rate for Payer: Multiplan Medicare/VA |
$544.73
|
| Rate for Payer: One Health Plan of WY PPO |
$921.20
|
| Rate for Payer: PacificSource Commercial |
$846.00
|
| Rate for Payer: PHCS PPO |
$921.20
|
| Rate for Payer: Three Rivers PPO |
$705.00
|
| Rate for Payer: TriWest Veterans Administration |
$573.40
|
| Rate for Payer: United Healthcare Commercial |
$897.70
|
| Rate for Payer: United Healthcare Medicare |
$573.40
|
| Rate for Payer: WINHealth Partners Commercial |
$893.00
|
| Rate for Payer: Wise Provider Network Commercial |
$893.00
|
|
|
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
3028603601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$25.60
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$23.18
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.40
|
| Rate for Payer: United Healthcare Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare |
$24.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
3028603601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.66 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.80
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$21.66
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$22.80
|
| Rate for Payer: United Healthcare Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.49
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$63.17
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.49
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$66.49
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.13
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$59.02
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.13
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.13
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$59.02
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.13
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.49
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$63.17
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.49
|
| Rate for Payer: United Healthcare Commercial |
$104.10
|
| Rate for Payer: United Healthcare Medicare |
$66.49
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 - ESCITALOPRAM LEVEL
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
3018034215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.67 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$145.86
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.97
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$119.67
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.97
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$125.97
|
| Rate for Payer: WINHealth Partners Commercial |
$216.58
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 - ESCITALOPRAM LEVEL
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
3018034215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.07 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$141.44
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.81
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$128.07
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$134.81
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$134.81
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86063
|
| Hospital Charge Code |
3028606301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.89
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$86.35
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$90.89
|
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: United Healthcare Medicare |
$90.89
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86063
|
| Hospital Charge Code |
3028606301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.93
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$80.68
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.93
|
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: United Healthcare Medicare |
$84.93
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
3028606001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$81.92
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.08
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$74.18
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.08
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$78.08
|
| Rate for Payer: WINHealth Partners Commercial |
$121.60
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
3028606001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$84.48
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.96
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$69.31
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$72.96
|
| Rate for Payer: WINHealth Partners Commercial |
$125.44
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$115.20
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$104.31
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.80
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$109.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.60
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$97.47
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.60
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$102.60
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN PANEL
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$234.12 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$258.56
|
| Rate for Payer: Altius Commercial |
$387.84
|
| Rate for Payer: Beech Street Commercial |
$395.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$391.88
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: Entrust Commercial |
$383.80
|
| Rate for Payer: First Choice Health Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.44
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$234.12
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$395.92
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$246.44
|
| Rate for Payer: United Healthcare Commercial |
$385.82
|
| Rate for Payer: United Healthcare Medicare |
$246.44
|
| Rate for Payer: Wise Provider Network Commercial |
$383.80
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN PANEL
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$218.77 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$266.64
|
| Rate for Payer: Altius Commercial |
$387.84
|
| Rate for Payer: Beech Street Commercial |
$395.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$391.88
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: Entrust Commercial |
$383.80
|
| Rate for Payer: First Choice Health Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$230.28
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$218.77
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$395.92
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$230.28
|
| Rate for Payer: United Healthcare Commercial |
$385.82
|
| Rate for Payer: United Healthcare Medicare |
$230.28
|
| Rate for Payer: WINHealth Partners Commercial |
$395.92
|
| Rate for Payer: Wise Provider Network Commercial |
$383.80
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$180.32
|
| Rate for Payer: Aetna of WY Medicare |
$117.76
|
| Rate for Payer: Altius Commercial |
$176.64
|
| Rate for Payer: Beech Street Commercial |
$180.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.48
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$178.48
|
| Rate for Payer: Cigna of WY Commercial |
$180.32
|
| Rate for Payer: Entrust Commercial |
$174.80
|
| Rate for Payer: First Choice Health Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.24
|
| Rate for Payer: HealthUtah PPO |
$184.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$178.48
|
| Rate for Payer: Multiplan Medicare/VA |
$106.63
|
| Rate for Payer: One Health Plan of WY PPO |
$180.32
|
| Rate for Payer: PacificSource Commercial |
$165.60
|
| Rate for Payer: PHCS PPO |
$180.32
|
| Rate for Payer: Three Rivers PPO |
$138.00
|
| Rate for Payer: TriWest Veterans Administration |
$112.24
|
| Rate for Payer: United Healthcare Commercial |
$175.72
|
| Rate for Payer: United Healthcare Medicare |
$112.24
|
| Rate for Payer: WINHealth Partners Commercial |
$174.80
|
| Rate for Payer: Wise Provider Network Commercial |
$174.80
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$180.32
|
| Rate for Payer: Aetna of WY Medicare |
$121.44
|
| Rate for Payer: Altius Commercial |
$176.64
|
| Rate for Payer: Beech Street Commercial |
$180.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.48
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$178.48
|
| Rate for Payer: Cigna of WY Commercial |
$180.32
|
| Rate for Payer: Entrust Commercial |
$174.80
|
| Rate for Payer: First Choice Health Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$174.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.88
|
| Rate for Payer: HealthUtah PPO |
$184.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$178.48
|
| Rate for Payer: Multiplan Medicare/VA |
$99.64
|
| Rate for Payer: One Health Plan of WY PPO |
$180.32
|
| Rate for Payer: PacificSource Commercial |
$165.60
|
| Rate for Payer: PHCS PPO |
$180.32
|
| Rate for Payer: Three Rivers PPO |
$138.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.88
|
| Rate for Payer: United Healthcare Commercial |
$175.72
|
| Rate for Payer: United Healthcare Medicare |
$104.88
|
| Rate for Payer: WINHealth Partners Commercial |
$180.32
|
| Rate for Payer: Wise Provider Network Commercial |
$174.80
|
|
|
HC APPL GNTLT-HND/LWR FOREARM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
7612908501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPL GNTLT-HND/LWR FOREARM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
7612908501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLICATION FOREARM CAST
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7612907501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.48 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Aetna of WY Medicare |
$72.32
|
| Rate for Payer: Altius Commercial |
$108.48
|
| Rate for Payer: Beech Street Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.61
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: Entrust Commercial |
$107.35
|
| Rate for Payer: First Choice Health Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.93
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$65.48
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$110.74
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: TriWest Veterans Administration |
$68.93
|
| Rate for Payer: United Healthcare Commercial |
$107.92
|
| Rate for Payer: United Healthcare Medicare |
$68.93
|
| Rate for Payer: WINHealth Partners Commercial |
$107.35
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
|
HC APPLICATION FOREARM CAST
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7612907501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.19 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Aetna of WY Medicare |
$74.58
|
| Rate for Payer: Altius Commercial |
$108.48
|
| Rate for Payer: Beech Street Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.61
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: Entrust Commercial |
$107.35
|
| Rate for Payer: First Choice Health Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.41
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$61.19
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$110.74
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$107.92
|
| Rate for Payer: United Healthcare Medicare |
$64.41
|
| Rate for Payer: WINHealth Partners Commercial |
$110.74
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
