|
HC EMG, NEEDLE, TWO LIMBS - EMG 2 LIMBS
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
9229586101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,465.66 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,606.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,755.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,553.60
|
| Rate for Payer: Altius Commercial |
$2,553.60
|
| Rate for Payer: Beech Street Commercial |
$2,606.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,183.86
|
| Rate for Payer: Cash Price |
$1,862.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,580.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,606.80
|
| Rate for Payer: Entrust Commercial |
$2,527.00
|
| Rate for Payer: First Choice Health Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,542.80
|
| Rate for Payer: HealthUtah PPO |
$2,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,580.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,465.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,606.80
|
| Rate for Payer: PacificSource Commercial |
$2,394.00
|
| Rate for Payer: PHCS PPO |
$2,606.80
|
| Rate for Payer: Three Rivers PPO |
$1,995.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,542.80
|
| Rate for Payer: United Healthcare Commercial |
$2,314.20
|
| Rate for Payer: United Healthcare Medicare |
$1,542.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,606.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,527.00
|
|
|
HC EMG, NEEDLE, TWO LIMBS - EMG 2 LIMBS
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
9229586101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,667.82 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,606.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,553.60
|
| Rate for Payer: Altius Commercial |
$2,553.60
|
| Rate for Payer: Beech Street Commercial |
$2,606.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,183.86
|
| Rate for Payer: Cash Price |
$1,862.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,580.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,606.80
|
| Rate for Payer: Entrust Commercial |
$2,527.00
|
| Rate for Payer: First Choice Health Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,755.60
|
| Rate for Payer: HealthUtah PPO |
$2,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,580.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,667.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,606.80
|
| Rate for Payer: PacificSource Commercial |
$2,394.00
|
| Rate for Payer: PHCS PPO |
$2,606.80
|
| Rate for Payer: Three Rivers PPO |
$1,995.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,755.60
|
| Rate for Payer: United Healthcare Commercial |
$2,314.20
|
| Rate for Payer: United Healthcare Medicare |
$1,755.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,527.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,527.00
|
|
|
HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGM
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3028665102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGM
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86651
|
| Hospital Charge Code |
3028665102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGM
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3028665302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGM
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86653
|
| Hospital Charge Code |
3028665302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
5105750501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$66.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.96
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.58
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$55.65
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$58.58
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$58.58
|
| Rate for Payer: WINHealth Partners Commercial |
$98.98
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
5105750501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.96
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.92
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.66
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$63.33
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.66
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$66.66
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 58110
|
| Hospital Charge Code |
5105811001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Aetna of WY Medicare |
$27.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
| Rate for Payer: Altius Commercial |
$39.36
|
| Rate for Payer: Beech Street Commercial |
$40.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: Entrust Commercial |
$38.95
|
| Rate for Payer: First Choice Health Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.78
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: Multiplan Medicare/VA |
$22.59
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$40.18
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.78
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$23.78
|
| Rate for Payer: WINHealth Partners Commercial |
$40.18
|
| Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
|
HC ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 58110
|
| Hospital Charge Code |
5105811001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.71 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
| Rate for Payer: Altius Commercial |
$39.36
|
| Rate for Payer: Beech Street Commercial |
$40.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: Entrust Commercial |
$38.95
|
| Rate for Payer: First Choice Health Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.06
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: Multiplan Medicare/VA |
$25.71
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$40.18
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.06
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$27.06
|
| Rate for Payer: WINHealth Partners Commercial |
$38.95
|
| Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
|
HC ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
5105810001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
5105810001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
3028623101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.76
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$22.57
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.76
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Medicare |
$23.76
|
| Rate for Payer: WINHealth Partners Commercial |
$34.20
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
3028623101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Aetna of WY Medicare |
$23.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.88
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$19.84
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Medicare |
$20.88
|
| Rate for Payer: WINHealth Partners Commercial |
$35.28
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
5103647501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$276.48
|
| Rate for Payer: Altius Commercial |
$276.48
|
| Rate for Payer: Beech Street Commercial |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$236.45
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: Entrust Commercial |
$273.60
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.08
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: Multiplan Medicare/VA |
$180.58
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$282.24
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.08
|
| Rate for Payer: United Healthcare Commercial |
$250.56
|
| Rate for Payer: United Healthcare Medicare |
$190.08
|
| Rate for Payer: WINHealth Partners Commercial |
$273.60
|
| Rate for Payer: Wise Provider Network Commercial |
$273.60
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
5103647501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.69 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Aetna of WY Medicare |
$190.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$276.48
|
| Rate for Payer: Altius Commercial |
$276.48
|
| Rate for Payer: Beech Street Commercial |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$236.45
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: Entrust Commercial |
$273.60
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.04
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: Multiplan Medicare/VA |
$158.69
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$282.24
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: TriWest Veterans Administration |
$167.04
|
| Rate for Payer: United Healthcare Commercial |
$250.56
|
| Rate for Payer: United Healthcare Medicare |
$167.04
|
| Rate for Payer: WINHealth Partners Commercial |
$282.24
|
| Rate for Payer: Wise Provider Network Commercial |
$273.60
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 36475 50
|
| Hospital Charge Code |
5103647501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$317.38 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Aetna of WY Medicare |
$380.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.96
|
| Rate for Payer: Altius Commercial |
$552.96
|
| Rate for Payer: Beech Street Commercial |
$564.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.90
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: Entrust Commercial |
$547.20
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.08
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$317.38
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$564.48
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$334.08
|
| Rate for Payer: United Healthcare Commercial |
$501.12
|
| Rate for Payer: United Healthcare Medicare |
$334.08
|
| Rate for Payer: WINHealth Partners Commercial |
$564.48
|
| Rate for Payer: Wise Provider Network Commercial |
$547.20
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 36475 50
|
| Hospital Charge Code |
5103647501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$361.15 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.96
|
| Rate for Payer: Altius Commercial |
$552.96
|
| Rate for Payer: Beech Street Commercial |
$564.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.90
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: Entrust Commercial |
$547.20
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$380.16
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$361.15
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$564.48
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$380.16
|
| Rate for Payer: United Healthcare Commercial |
$501.12
|
| Rate for Payer: United Healthcare Medicare |
$380.16
|
| Rate for Payer: WINHealth Partners Commercial |
$547.20
|
| Rate for Payer: Wise Provider Network Commercial |
$547.20
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIEVIRUS A9 ANTIBODIES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIEVIRUS A9 ANTIBODIES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIEVIRUS B ANTIBODIES
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIEVIRUS B ANTIBODIES
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ENTEROVIRUS ANTIBODY - ENTEROVIRUS PANEL
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ENTEROVIRUS ANTIBODY - ENTEROVIRUS PANEL
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC ENTEROVIRUS ANTIBODY - POLIOVIRUS ANTIBODIES, TYPES 1, 2, AND 3
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
3028665802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
