|
HC ARTHROCNT ASPIR INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4022060401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$715.10 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,209.32
|
| Rate for Payer: Aetna of WY Medicare |
$789.76
|
| Rate for Payer: Altius Commercial |
$1,184.64
|
| Rate for Payer: Beech Street Commercial |
$1,209.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,196.98
|
| Rate for Payer: Cash Price |
$863.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,196.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,209.32
|
| Rate for Payer: Entrust Commercial |
$1,172.30
|
| Rate for Payer: First Choice Health Commercial |
$1,172.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,172.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$752.74
|
| Rate for Payer: HealthUtah PPO |
$1,234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,196.98
|
| Rate for Payer: Multiplan Medicare/VA |
$715.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,209.32
|
| Rate for Payer: PacificSource Commercial |
$1,110.60
|
| Rate for Payer: PHCS PPO |
$1,209.32
|
| Rate for Payer: Three Rivers PPO |
$925.50
|
| Rate for Payer: TriWest Veterans Administration |
$752.74
|
| Rate for Payer: United Healthcare Commercial |
$1,178.47
|
| Rate for Payer: United Healthcare Medicare |
$752.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,172.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,172.30
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM LEFT
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304001
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$654.67 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,184.82
|
| Rate for Payer: Aetna of WY Medicare |
$797.94
|
| Rate for Payer: Altius Commercial |
$1,160.64
|
| Rate for Payer: Beech Street Commercial |
$1,184.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,172.73
|
| Rate for Payer: Cash Price |
$846.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,172.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,184.82
|
| Rate for Payer: Entrust Commercial |
$1,148.55
|
| Rate for Payer: First Choice Health Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.13
|
| Rate for Payer: HealthUtah PPO |
$1,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,172.73
|
| Rate for Payer: Multiplan Medicare/VA |
$654.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,184.82
|
| Rate for Payer: PacificSource Commercial |
$1,088.10
|
| Rate for Payer: PHCS PPO |
$1,184.82
|
| Rate for Payer: Three Rivers PPO |
$906.75
|
| Rate for Payer: TriWest Veterans Administration |
$689.13
|
| Rate for Payer: United Healthcare Commercial |
$1,154.60
|
| Rate for Payer: United Healthcare Medicare |
$689.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,184.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,148.55
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM LEFT
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304001
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$700.62 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,184.82
|
| Rate for Payer: Aetna of WY Medicare |
$773.76
|
| Rate for Payer: Altius Commercial |
$1,160.64
|
| Rate for Payer: Beech Street Commercial |
$1,184.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,172.73
|
| Rate for Payer: Cash Price |
$846.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,172.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,184.82
|
| Rate for Payer: Entrust Commercial |
$1,148.55
|
| Rate for Payer: First Choice Health Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$737.49
|
| Rate for Payer: HealthUtah PPO |
$1,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,172.73
|
| Rate for Payer: Multiplan Medicare/VA |
$700.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,184.82
|
| Rate for Payer: PacificSource Commercial |
$1,088.10
|
| Rate for Payer: PHCS PPO |
$1,184.82
|
| Rate for Payer: Three Rivers PPO |
$906.75
|
| Rate for Payer: TriWest Veterans Administration |
$737.49
|
| Rate for Payer: United Healthcare Commercial |
$1,154.60
|
| Rate for Payer: United Healthcare Medicare |
$737.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,148.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,148.55
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304002
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$654.67 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,184.82
|
| Rate for Payer: Aetna of WY Medicare |
$797.94
|
| Rate for Payer: Altius Commercial |
$1,160.64
|
| Rate for Payer: Beech Street Commercial |
$1,184.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,172.73
|
| Rate for Payer: Cash Price |
$846.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,172.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,184.82
|
| Rate for Payer: Entrust Commercial |
$1,148.55
|
| Rate for Payer: First Choice Health Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$689.13
|
| Rate for Payer: HealthUtah PPO |
$1,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,172.73
|
| Rate for Payer: Multiplan Medicare/VA |
$654.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,184.82
|
| Rate for Payer: PacificSource Commercial |
$1,088.10
|
| Rate for Payer: PHCS PPO |
$1,184.82
|
| Rate for Payer: Three Rivers PPO |
$906.75
|
| Rate for Payer: TriWest Veterans Administration |
$689.13
|
| Rate for Payer: United Healthcare Commercial |
$1,154.60
|
| Rate for Payer: United Healthcare Medicare |
$689.13
|
| Rate for Payer: WINHealth Partners Commercial |
$1,184.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,148.55
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304002
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$700.62 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,184.82
|
| Rate for Payer: Aetna of WY Medicare |
$773.76
|
| Rate for Payer: Altius Commercial |
$1,160.64
|
| Rate for Payer: Beech Street Commercial |
$1,184.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,172.73
|
| Rate for Payer: Cash Price |
$846.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,172.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,184.82
|
| Rate for Payer: Entrust Commercial |
$1,148.55
|
| Rate for Payer: First Choice Health Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,148.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$737.49
|
| Rate for Payer: HealthUtah PPO |
$1,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,172.73
|
| Rate for Payer: Multiplan Medicare/VA |
$700.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,184.82
|
| Rate for Payer: PacificSource Commercial |
$1,088.10
|
| Rate for Payer: PHCS PPO |
$1,184.82
|
| Rate for Payer: Three Rivers PPO |
$906.75
|
| Rate for Payer: TriWest Veterans Administration |
$737.49
|
| Rate for Payer: United Healthcare Commercial |
$1,154.60
|
| Rate for Payer: United Healthcare Medicare |
$737.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,148.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,148.55
|
|
|
HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3028660601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Aetna of WY Medicare |
$129.92
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.91
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.83
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$117.64
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$123.83
|
| Rate for Payer: United Healthcare Commercial |
$193.86
|
| Rate for Payer: United Healthcare Medicare |
$123.83
|
| Rate for Payer: WINHealth Partners Commercial |
$192.85
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
3028660601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Aetna of WY Medicare |
$133.98
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.91
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.71
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$109.92
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.71
|
| Rate for Payer: United Healthcare Commercial |
$193.86
|
| Rate for Payer: United Healthcare Medicare |
$115.71
|
| Rate for Payer: WINHealth Partners Commercial |
$198.94
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
3612061201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
3612061201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
5102061201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: United Healthcare Commercial |
$31.52
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.12
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.01
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.13
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$19.12
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.13
|
| Rate for Payer: United Healthcare Medicare |
$20.13
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
5102061201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.01
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.81
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$17.87
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$18.81
|
| Rate for Payer: United Healthcare Commercial |
$31.52
|
| Rate for Payer: United Healthcare Medicare |
$18.81
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC ASSAY 17-(17-KS)KETOSTEROIDS - 17 KETOSTEROIDS,24HR URINE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 83586
|
| Hospital Charge Code |
3018358601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ASSAY 17-(17-KS)KETOSTEROIDS - 17 KETOSTEROIDS,24HR URINE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 83586
|
| Hospital Charge Code |
3018358601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$70.40
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$63.74
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ASSAY ADENOVIRUS ANTIGEN STOOL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
3008730101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.71
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$55.77
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$58.71
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$58.71
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC ASSAY ADENOVIRUS ANTIGEN STOOL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 87301
|
| Hospital Charge Code |
3008730101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$65.92
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.83
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$59.69
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.83
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$62.83
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
3018407501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$28.80
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.45
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$26.08
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.45
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Medicare |
$27.45
|
| Rate for Payer: WINHealth Partners Commercial |
$42.75
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
3018407501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$29.70
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.65
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$24.37
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$25.65
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Medicare |
$25.65
|
| Rate for Payer: WINHealth Partners Commercial |
$44.10
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE BONE SPECIFIC
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
3018407504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$31.36
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.53
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.89
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$28.40
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.89
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Medicare |
$29.89
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE BONE SPECIFIC
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
3018407504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$32.34
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.53
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.93
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$26.53
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.93
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Medicare |
$27.93
|
| Rate for Payer: WINHealth Partners Commercial |
$48.02
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
3018408001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.65 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$73.92
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.84
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$60.65
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.84
|
| Rate for Payer: United Healthcare Commercial |
$106.96
|
| Rate for Payer: United Healthcare Medicare |
$63.84
|
| Rate for Payer: WINHealth Partners Commercial |
$109.76
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
3018408001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.90 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$71.68
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.64
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.32
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$64.90
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.32
|
| Rate for Payer: United Healthcare Commercial |
$106.96
|
| Rate for Payer: United Healthcare Medicare |
$68.32
|
| Rate for Payer: WINHealth Partners Commercial |
$106.40
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC ASSAY BIOTINIDASE - BIOTINIDASE LEVEL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
3018226101
|
|
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 ASSAY BIOTINIDASE - BIOTINIDASE LEVEL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
3018226101
|
|
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
|
|
