|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
3018238401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.93 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.42
|
| Rate for Payer: Aetna of WY Medicare |
$118.14
|
| Rate for Payer: Altius Commercial |
$171.84
|
| Rate for Payer: Beech Street Commercial |
$175.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.63
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.63
|
| Rate for Payer: Cigna of WY Commercial |
$175.42
|
| Rate for Payer: Entrust Commercial |
$170.05
|
| Rate for Payer: First Choice Health Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.03
|
| Rate for Payer: HealthUtah PPO |
$179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.63
|
| Rate for Payer: Multiplan Medicare/VA |
$96.93
|
| Rate for Payer: One Health Plan of WY PPO |
$175.42
|
| Rate for Payer: PacificSource Commercial |
$161.10
|
| Rate for Payer: PHCS PPO |
$175.42
|
| Rate for Payer: Three Rivers PPO |
$134.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.03
|
| Rate for Payer: United Healthcare Commercial |
$170.94
|
| Rate for Payer: United Healthcare Medicare |
$102.03
|
| Rate for Payer: WINHealth Partners Commercial |
$175.42
|
| Rate for Payer: Wise Provider Network Commercial |
$170.05
|
|
|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
3018238401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.73 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.42
|
| Rate for Payer: Aetna of WY Medicare |
$114.56
|
| Rate for Payer: Altius Commercial |
$171.84
|
| Rate for Payer: Beech Street Commercial |
$175.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.63
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.63
|
| Rate for Payer: Cigna of WY Commercial |
$175.42
|
| Rate for Payer: Entrust Commercial |
$170.05
|
| Rate for Payer: First Choice Health Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.19
|
| Rate for Payer: HealthUtah PPO |
$179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.63
|
| Rate for Payer: Multiplan Medicare/VA |
$103.73
|
| Rate for Payer: One Health Plan of WY PPO |
$175.42
|
| Rate for Payer: PacificSource Commercial |
$161.10
|
| Rate for Payer: PHCS PPO |
$175.42
|
| Rate for Payer: Three Rivers PPO |
$134.25
|
| Rate for Payer: TriWest Veterans Administration |
$109.19
|
| Rate for Payer: United Healthcare Commercial |
$170.94
|
| Rate for Payer: United Healthcare Medicare |
$109.19
|
| Rate for Payer: WINHealth Partners Commercial |
$170.05
|
| Rate for Payer: Wise Provider Network Commercial |
$170.05
|
|
|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
3018238402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$94.76
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$99.75
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
3018238402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$112.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$101.41
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
3018444301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$116.82
|
| Rate for Payer: Altius Commercial |
$169.92
|
| Rate for Payer: Beech Street Commercial |
$173.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$171.69
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: Entrust Commercial |
$168.15
|
| Rate for Payer: First Choice Health Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.89
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$95.85
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$173.46
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.89
|
| Rate for Payer: United Healthcare Commercial |
$169.04
|
| Rate for Payer: United Healthcare Medicare |
$100.89
|
| Rate for Payer: WINHealth Partners Commercial |
$173.46
|
| Rate for Payer: Wise Provider Network Commercial |
$168.15
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
3018444301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$113.28
|
| Rate for Payer: Altius Commercial |
$169.92
|
| Rate for Payer: Beech Street Commercial |
$173.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$171.69
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: Entrust Commercial |
$168.15
|
| Rate for Payer: First Choice Health Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.97
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$102.57
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$173.46
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.97
|
| Rate for Payer: United Healthcare Commercial |
$169.04
|
| Rate for Payer: United Healthcare Medicare |
$107.97
|
| Rate for Payer: WINHealth Partners Commercial |
$168.15
|
| Rate for Payer: Wise Provider Network Commercial |
$168.15
|
|
|
HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 87230
|
| Hospital Charge Code |
3068723001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$79.36
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.64
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$71.86
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$75.64
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$75.64
|
| Rate for Payer: WINHealth Partners Commercial |
$117.80
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 87230
|
| Hospital Charge Code |
3068723001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$81.84
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.68
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$67.15
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.68
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$70.68
|
| Rate for Payer: WINHealth Partners Commercial |
$121.52
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ASSAY TYROSINE - TYROSINE
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
3018451001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$60.72
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.44
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.82
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.44
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
| Rate for Payer: WINHealth Partners Commercial |
$90.16
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY TYROSINE - TYROSINE
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
3018451001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.88
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.12
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$53.31
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.12
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$56.12
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$38.94
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.23
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.63
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$31.95
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.63
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
| Rate for Payer: United Healthcare Medicare |
$33.63
|
| Rate for Payer: WINHealth Partners Commercial |
$57.82
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$37.76
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.23
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.99
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$34.19
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.99
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
| Rate for Payer: United Healthcare Medicare |
$35.99
|
| Rate for Payer: WINHealth Partners Commercial |
$56.05
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC ASSAY URINE UREA-N - UREA NITROGEN, URINE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
3018454002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$22.40
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.95
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.35
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$21.35
|
| Rate for Payer: United Healthcare Commercial |
$33.42
|
| Rate for Payer: United Healthcare Medicare |
$21.35
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC ASSAY URINE UREA-N - UREA NITROGEN, URINE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
3018454002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.95
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.95
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$18.95
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$19.95
|
| Rate for Payer: United Healthcare Commercial |
$33.42
|
| Rate for Payer: United Healthcare Medicare |
$19.95
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC AUTOTRANSFUSION
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
HCPCS 36513
|
| Hospital Charge Code |
3603651301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,023.98 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,731.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,130.88
|
| Rate for Payer: Altius Commercial |
$1,696.32
|
| Rate for Payer: Beech Street Commercial |
$1,731.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,713.99
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,713.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,731.66
|
| Rate for Payer: Entrust Commercial |
$1,678.65
|
| Rate for Payer: First Choice Health Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,077.87
|
| Rate for Payer: HealthUtah PPO |
$1,767.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,713.99
|
| Rate for Payer: Multiplan Medicare/VA |
$1,023.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,731.66
|
| Rate for Payer: PacificSource Commercial |
$1,590.30
|
| Rate for Payer: PHCS PPO |
$1,731.66
|
| Rate for Payer: Three Rivers PPO |
$1,325.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,077.87
|
| Rate for Payer: United Healthcare Commercial |
$1,687.48
|
| Rate for Payer: United Healthcare Medicare |
$1,077.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,678.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,678.65
|
|
|
HC AUTOTRANSFUSION
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
HCPCS 36513
|
| Hospital Charge Code |
3603651301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.83 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: WINHealth Partners Commercial |
$1,731.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,731.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,166.22
|
| Rate for Payer: Altius Commercial |
$1,696.32
|
| Rate for Payer: Beech Street Commercial |
$1,731.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,713.99
|
| Rate for Payer: Cash Price |
$1,236.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,713.99
|
| Rate for Payer: Cigna of WY Commercial |
$1,731.66
|
| Rate for Payer: Entrust Commercial |
$1,678.65
|
| Rate for Payer: First Choice Health Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,678.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,007.19
|
| Rate for Payer: HealthUtah PPO |
$1,767.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,713.99
|
| Rate for Payer: Multiplan Medicare/VA |
$956.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,731.66
|
| Rate for Payer: PacificSource Commercial |
$1,590.30
|
| Rate for Payer: PHCS PPO |
$1,731.66
|
| Rate for Payer: Three Rivers PPO |
$1,325.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,007.19
|
| Rate for Payer: United Healthcare Commercial |
$1,687.48
|
| Rate for Payer: United Healthcare Medicare |
$1,007.19
|
| Rate for Payer: Wise Provider Network Commercial |
$1,678.65
|
|
|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
5101173001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.71
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.51
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.28
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.51
|
| Rate for Payer: United Healthcare Commercial |
$41.06
|
| Rate for Payer: United Healthcare Medicare |
$24.51
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
5101173001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$27.52
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.71
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.23
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.92
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.23
|
| Rate for Payer: United Healthcare Commercial |
$41.06
|
| Rate for Payer: United Healthcare Medicare |
$26.23
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
5101173201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.24
|
| Rate for Payer: Altius Commercial |
$13.44
|
| Rate for Payer: Beech Street Commercial |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.58
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: Entrust Commercial |
$13.30
|
| Rate for Payer: First Choice Health Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.98
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$7.58
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.72
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$7.98
|
| Rate for Payer: United Healthcare Commercial |
$13.37
|
| Rate for Payer: United Healthcare Medicare |
$7.98
|
| Rate for Payer: WINHealth Partners Commercial |
$13.72
|
| Rate for Payer: Wise Provider Network Commercial |
$13.30
|
|
|
HC AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
5101173201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$8.96
|
| Rate for Payer: Altius Commercial |
$13.44
|
| Rate for Payer: Beech Street Commercial |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.58
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: Entrust Commercial |
$13.30
|
| Rate for Payer: First Choice Health Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.54
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.11
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.72
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$13.37
|
| Rate for Payer: United Healthcare Medicare |
$8.54
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
| Rate for Payer: Wise Provider Network Commercial |
$13.30
|
|
|
HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$57.60
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.90
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.30
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC BACTERIA CULTURE SCREEN - NASAL MRSA
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.30
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC BACTERIA CULTURE SCREEN - NASAL MRSA
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$57.60
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.90
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC BACTERIA CULTURE SCREEN - STREP CULTURE GRP A
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708103
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$57.60
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.90
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
