|
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
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ENZYME ACTIVITY NONRADIOACTIVE SUBSTRATE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
3018265701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.30
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$191.24
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$201.30
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC ENZYME ACTIVITY NONRADIOACTIVE SUBSTRATE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
3018265701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$201.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.90
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$168.06
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$176.90
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$176.90
|
| Rate for Payer: WINHealth Partners Commercial |
$298.90
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC ENZYME HISTOCHEMISTRY - LAB ENZYME HISTOCHEMISTRY
|
Facility
|
OP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
3128831901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$2,347.26 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,174.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,811.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,089.60
|
| Rate for Payer: Altius Commercial |
$4,089.60
|
| Rate for Payer: Beech Street Commercial |
$4,174.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,497.46
|
| Rate for Payer: Cash Price |
$2,982.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,132.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,174.80
|
| Rate for Payer: Entrust Commercial |
$4,047.00
|
| Rate for Payer: First Choice Health Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,470.80
|
| Rate for Payer: HealthUtah PPO |
$4,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,132.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,347.26
|
| Rate for Payer: One Health Plan of WY PPO |
$4,174.80
|
| Rate for Payer: PacificSource Commercial |
$3,834.00
|
| Rate for Payer: PHCS PPO |
$4,174.80
|
| Rate for Payer: Three Rivers PPO |
$3,195.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,470.80
|
| Rate for Payer: United Healthcare Commercial |
$3,706.20
|
| Rate for Payer: United Healthcare Medicare |
$2,470.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,174.80
|
| Rate for Payer: Wise Provider Network Commercial |
$4,047.00
|
|
|
HC ENZYME HISTOCHEMISTRY - LAB ENZYME HISTOCHEMISTRY
|
Facility
|
IP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
3128831901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$2,671.02 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,174.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,089.60
|
| Rate for Payer: Altius Commercial |
$4,089.60
|
| Rate for Payer: Beech Street Commercial |
$4,174.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,497.46
|
| Rate for Payer: Cash Price |
$2,982.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,132.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,174.80
|
| Rate for Payer: Entrust Commercial |
$4,047.00
|
| Rate for Payer: First Choice Health Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,811.60
|
| Rate for Payer: HealthUtah PPO |
$4,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,132.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,671.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,174.80
|
| Rate for Payer: PacificSource Commercial |
$3,834.00
|
| Rate for Payer: PHCS PPO |
$4,174.80
|
| Rate for Payer: Three Rivers PPO |
$3,195.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,811.60
|
| Rate for Payer: United Healthcare Commercial |
$3,706.20
|
| Rate for Payer: United Healthcare Medicare |
$2,811.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,047.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,047.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGA
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGA
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC - ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
5104320001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,247.10 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,909.44
|
| Rate for Payer: Altius Commercial |
$1,909.44
|
| Rate for Payer: Beech Street Commercial |
$1,949.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,632.97
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: Entrust Commercial |
$1,889.55
|
| Rate for Payer: First Choice Health Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,312.74
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,247.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PHCS PPO |
$1,949.22
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,312.74
|
| Rate for Payer: United Healthcare Commercial |
$1,730.43
|
| Rate for Payer: United Healthcare Medicare |
$1,312.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,889.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,889.55
|
|
|
HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC - ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
5104320001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,095.94 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,312.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,909.44
|
| Rate for Payer: Altius Commercial |
$1,909.44
|
| Rate for Payer: Beech Street Commercial |
$1,949.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,632.97
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: Entrust Commercial |
$1,889.55
|
| Rate for Payer: First Choice Health Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,153.62
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,095.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PHCS PPO |
$1,949.22
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,153.62
|
| Rate for Payer: United Healthcare Commercial |
$1,730.43
|
| Rate for Payer: United Healthcare Medicare |
$1,153.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,949.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1,889.55
|
|
|
HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
3207422001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$260.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.10
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$217.64
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.10
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$387.10
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
3207422001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.66 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.70
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$247.66
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$260.70
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
| Rate for Payer: WINHealth Partners Commercial |
$375.25
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5101174001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Aetna of WY Medicare |
$21.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.72
|
| Rate for Payer: Altius Commercial |
$30.72
|
| Rate for Payer: Beech Street Commercial |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: Entrust Commercial |
$30.40
|
| Rate for Payer: First Choice Health Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.56
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: Multiplan Medicare/VA |
$17.63
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$31.36
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$18.56
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$18.56
|
| Rate for Payer: WINHealth Partners Commercial |
$31.36
|
| Rate for Payer: Wise Provider Network Commercial |
$30.40
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
5101174001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.72
|
| Rate for Payer: Altius Commercial |
$30.72
|
| Rate for Payer: Beech Street Commercial |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.27
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: Entrust Commercial |
$30.40
|
| Rate for Payer: First Choice Health Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.12
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: Multiplan Medicare/VA |
$20.06
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$31.36
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$21.12
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$21.12
|
| Rate for Payer: WINHealth Partners Commercial |
$30.40
|
| Rate for Payer: Wise Provider Network Commercial |
$30.40
|
|
|
HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
4609407001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 94070
|
| Hospital Charge Code |
4609407001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
4609406001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$325.09 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Aetna of WY Medicare |
$389.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
| Rate for Payer: Altius Commercial |
$566.40
|
| Rate for Payer: Beech Street Commercial |
$578.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: Entrust Commercial |
$560.50
|
| Rate for Payer: First Choice Health Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$342.20
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Multiplan Medicare/VA |
$325.09
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PHCS PPO |
$578.20
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: TriWest Veterans Administration |
$342.20
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$342.20
|
| Rate for Payer: WINHealth Partners Commercial |
$578.20
|
| Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
|
HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
4609406001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$369.93 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
| Rate for Payer: Altius Commercial |
$566.40
|
| Rate for Payer: Beech Street Commercial |
$578.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: Entrust Commercial |
$560.50
|
| Rate for Payer: First Choice Health Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.40
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Multiplan Medicare/VA |
$369.93
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PHCS PPO |
$578.20
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: TriWest Veterans Administration |
$389.40
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$389.40
|
| Rate for Payer: WINHealth Partners Commercial |
$560.50
|
| Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
