|
HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 24071
|
| Hospital Charge Code |
5102407101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.54
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$105.96
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$111.54
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$111.54
|
| Rate for Payer: WINHealth Partners Commercial |
$160.55
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
5102407501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.08
|
| Rate for Payer: Altius Commercial |
$238.08
|
| Rate for Payer: Beech Street Commercial |
$243.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.61
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$240.56
|
| Rate for Payer: Cigna of WY Commercial |
$243.04
|
| Rate for Payer: Entrust Commercial |
$235.60
|
| Rate for Payer: First Choice Health Commercial |
$235.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$235.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.68
|
| Rate for Payer: HealthUtah PPO |
$248.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$240.56
|
| Rate for Payer: Multiplan Medicare/VA |
$155.50
|
| Rate for Payer: One Health Plan of WY PPO |
$243.04
|
| Rate for Payer: PacificSource Commercial |
$223.20
|
| Rate for Payer: PHCS PPO |
$243.04
|
| Rate for Payer: Three Rivers PPO |
$186.00
|
| Rate for Payer: TriWest Veterans Administration |
$163.68
|
| Rate for Payer: United Healthcare Commercial |
$215.76
|
| Rate for Payer: United Healthcare Medicare |
$163.68
|
| Rate for Payer: WINHealth Partners Commercial |
$235.60
|
| Rate for Payer: Wise Provider Network Commercial |
$235.60
|
|
|
HC EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
5102407501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.65 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.04
|
| Rate for Payer: Aetna of WY Medicare |
$163.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.08
|
| Rate for Payer: Altius Commercial |
$238.08
|
| Rate for Payer: Beech Street Commercial |
$243.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.61
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$240.56
|
| Rate for Payer: Cigna of WY Commercial |
$243.04
|
| Rate for Payer: Entrust Commercial |
$235.60
|
| Rate for Payer: First Choice Health Commercial |
$235.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$235.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.84
|
| Rate for Payer: HealthUtah PPO |
$248.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$240.56
|
| Rate for Payer: Multiplan Medicare/VA |
$136.65
|
| Rate for Payer: One Health Plan of WY PPO |
$243.04
|
| Rate for Payer: PacificSource Commercial |
$223.20
|
| Rate for Payer: PHCS PPO |
$243.04
|
| Rate for Payer: Three Rivers PPO |
$186.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.84
|
| Rate for Payer: United Healthcare Commercial |
$215.76
|
| Rate for Payer: United Healthcare Medicare |
$143.84
|
| Rate for Payer: WINHealth Partners Commercial |
$243.04
|
| Rate for Payer: Wise Provider Network Commercial |
$235.60
|
|
|
HC EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
5102611601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,317.33 |
| Max. Negotiated Rate |
$2,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.96
|
| Rate for Payer: Altius Commercial |
$2,016.96
|
| Rate for Payer: Beech Street Commercial |
$2,058.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.92
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.98
|
| Rate for Payer: Entrust Commercial |
$1,995.95
|
| Rate for Payer: First Choice Health Commercial |
$1,995.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,386.66
|
| Rate for Payer: HealthUtah PPO |
$2,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,317.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.98
|
| Rate for Payer: PacificSource Commercial |
$1,890.90
|
| Rate for Payer: PHCS PPO |
$2,058.98
|
| Rate for Payer: Three Rivers PPO |
$1,575.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,386.66
|
| Rate for Payer: United Healthcare Commercial |
$1,827.87
|
| Rate for Payer: United Healthcare Medicare |
$1,386.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,995.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.95
|
|
|
HC EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
5102611601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,157.65 |
| Max. Negotiated Rate |
$2,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,386.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.96
|
| Rate for Payer: Altius Commercial |
$2,016.96
|
| Rate for Payer: Beech Street Commercial |
$2,058.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.92
|
| Rate for Payer: Cash Price |
$1,470.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.98
|
| Rate for Payer: Entrust Commercial |
$1,995.95
|
| Rate for Payer: First Choice Health Commercial |
$1,995.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,218.58
|
| Rate for Payer: HealthUtah PPO |
$2,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,157.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.98
|
| Rate for Payer: PacificSource Commercial |
$1,890.90
|
| Rate for Payer: PHCS PPO |
$2,058.98
|
| Rate for Payer: Three Rivers PPO |
$1,575.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,218.58
|
| Rate for Payer: United Healthcare Commercial |
$1,827.87
|
| Rate for Payer: United Healthcare Medicare |
$1,218.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,058.98
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.95
|
|
|
HC EXPLORE PENETRATING WOUND,EXTREMITY
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
7612010301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC EXPLORE PENETRATING WOUND,EXTREMITY
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
7612010301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322502
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Aetna of WY Medicare |
$247.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$206.62
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$217.50
|
| Rate for Payer: WINHealth Partners Commercial |
$367.50
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322502
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$235.12 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$235.12
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$356.25
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322503
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$235.12 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$235.12
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$356.25
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322503
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Aetna of WY Medicare |
$247.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$206.62
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$217.50
|
| Rate for Payer: WINHealth Partners Commercial |
$367.50
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 72 HOUR
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$235.12 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$235.12
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$356.25
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 72 HOUR
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
7319322501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Aetna of WY Medicare |
$247.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$206.62
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$217.50
|
| Rate for Payer: WINHealth Partners Commercial |
$367.50
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC EXTENDED STAY RECOVERY HOURLY - NURSING UNIT
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
7100000011
|
|
Hospital Revenue Code
|
710
|
| 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 EXTENDED STAY RECOVERY HOURLY - NURSING UNIT
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
7100000011
|
|
Hospital Revenue Code
|
710
|
| 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 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623513
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623513
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - CHROMATIN NUCLEOSOMAL AB
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - CHROMATIN NUCLEOSOMAL AB
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - FIBRILLARIN (U3 RNP) ANTIBODY
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - FIBRILLARIN (U3 RNP) ANTIBODY
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY -MI-2 (NUCLEAR HELICASE PROTEIN)
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623512
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$172.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY -MI-2 (NUCLEAR HELICASE PROTEIN)
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623512
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$151.52
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$159.50
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - SMITH ANTIBODY
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - SMITH ANTIBODY
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
