|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$142.08
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.42
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$128.65
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.42
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WINHealth Partners Commercial |
$210.90
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.54
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$120.21
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.54
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$126.54
|
| Rate for Payer: WINHealth Partners Commercial |
$217.56
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
|
HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
3068748001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$87.68
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.89
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.57
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$79.39
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$83.57
|
| Rate for Payer: United Healthcare Commercial |
$130.84
|
| Rate for Payer: United Healthcare Medicare |
$83.57
|
| Rate for Payer: WINHealth Partners Commercial |
$130.15
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
3068748001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$90.42
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.89
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.09
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$74.19
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.09
|
| Rate for Payer: United Healthcare Commercial |
$130.84
|
| Rate for Payer: United Healthcare Medicare |
$78.09
|
| Rate for Payer: WINHealth Partners Commercial |
$134.26
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
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 CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
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 CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$741.86 |
| Max. Negotiated Rate |
$1,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,342.60
|
| Rate for Payer: Aetna of WY Medicare |
$904.20
|
| Rate for Payer: Altius Commercial |
$1,315.20
|
| Rate for Payer: Beech Street Commercial |
$1,342.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,328.90
|
| Rate for Payer: Cash Price |
$959.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,328.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,342.60
|
| Rate for Payer: Entrust Commercial |
$1,301.50
|
| Rate for Payer: First Choice Health Commercial |
$1,301.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,301.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$780.90
|
| Rate for Payer: HealthUtah PPO |
$1,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,328.90
|
| Rate for Payer: Multiplan Medicare/VA |
$741.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,342.60
|
| Rate for Payer: PacificSource Commercial |
$1,233.00
|
| Rate for Payer: PHCS PPO |
$1,342.60
|
| Rate for Payer: Three Rivers PPO |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration |
$780.90
|
| Rate for Payer: United Healthcare Commercial |
$1,308.35
|
| Rate for Payer: United Healthcare Medicare |
$780.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,342.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,301.50
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$793.92 |
| Max. Negotiated Rate |
$1,370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,342.60
|
| Rate for Payer: Aetna of WY Medicare |
$876.80
|
| Rate for Payer: Altius Commercial |
$1,315.20
|
| Rate for Payer: Beech Street Commercial |
$1,342.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,328.90
|
| Rate for Payer: Cash Price |
$959.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,328.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,342.60
|
| Rate for Payer: Entrust Commercial |
$1,301.50
|
| Rate for Payer: First Choice Health Commercial |
$1,301.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,301.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$835.70
|
| Rate for Payer: HealthUtah PPO |
$1,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,328.90
|
| Rate for Payer: Multiplan Medicare/VA |
$793.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,342.60
|
| Rate for Payer: PacificSource Commercial |
$1,233.00
|
| Rate for Payer: PHCS PPO |
$1,342.60
|
| Rate for Payer: Three Rivers PPO |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration |
$835.70
|
| Rate for Payer: United Healthcare Commercial |
$1,308.35
|
| Rate for Payer: United Healthcare Medicare |
$835.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,301.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,301.50
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,270.26 |
| Max. Negotiated Rate |
$2,192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,148.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,402.88
|
| Rate for Payer: Altius Commercial |
$2,104.32
|
| Rate for Payer: Beech Street Commercial |
$2,148.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,126.24
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,126.24
|
| Rate for Payer: Cigna of WY Commercial |
$2,148.16
|
| Rate for Payer: Entrust Commercial |
$2,082.40
|
| Rate for Payer: First Choice Health Commercial |
$2,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,337.12
|
| Rate for Payer: HealthUtah PPO |
$2,192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,126.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,270.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,148.16
|
| Rate for Payer: PacificSource Commercial |
$1,972.80
|
| Rate for Payer: PHCS PPO |
$2,148.16
|
| Rate for Payer: Three Rivers PPO |
$1,644.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,337.12
|
| Rate for Payer: United Healthcare Commercial |
$2,093.36
|
| Rate for Payer: United Healthcare Medicare |
$1,337.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,082.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,082.40
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,186.97 |
| Max. Negotiated Rate |
$2,192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,148.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,446.72
|
| Rate for Payer: Altius Commercial |
$2,104.32
|
| Rate for Payer: Beech Street Commercial |
$2,148.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,126.24
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,126.24
|
| Rate for Payer: Cigna of WY Commercial |
$2,148.16
|
| Rate for Payer: Entrust Commercial |
$2,082.40
|
| Rate for Payer: First Choice Health Commercial |
$2,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,082.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,249.44
|
| Rate for Payer: HealthUtah PPO |
$2,192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,126.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,186.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,148.16
|
| Rate for Payer: PacificSource Commercial |
$1,972.80
|
| Rate for Payer: PHCS PPO |
$2,148.16
|
| Rate for Payer: Three Rivers PPO |
$1,644.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,249.44
|
| Rate for Payer: United Healthcare Commercial |
$2,093.36
|
| Rate for Payer: United Healthcare Medicare |
$1,249.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2,148.16
|
| Rate for Payer: Wise Provider Network Commercial |
$2,082.40
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$779.22 |
| Max. Negotiated Rate |
$1,439.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,410.22
|
| Rate for Payer: Aetna of WY Medicare |
$949.74
|
| Rate for Payer: Altius Commercial |
$1,381.44
|
| Rate for Payer: Beech Street Commercial |
$1,410.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.83
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,395.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,410.22
|
| Rate for Payer: Entrust Commercial |
$1,367.05
|
| Rate for Payer: First Choice Health Commercial |
$1,367.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,367.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.23
|
| Rate for Payer: HealthUtah PPO |
$1,439.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,395.83
|
| Rate for Payer: Multiplan Medicare/VA |
$779.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,410.22
|
| Rate for Payer: PacificSource Commercial |
$1,295.10
|
| Rate for Payer: PHCS PPO |
$1,410.22
|
| Rate for Payer: Three Rivers PPO |
$1,079.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.23
|
| Rate for Payer: United Healthcare Commercial |
$1,374.24
|
| Rate for Payer: United Healthcare Medicare |
$820.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,410.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1,367.05
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$833.90 |
| Max. Negotiated Rate |
$1,439.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,410.22
|
| Rate for Payer: Aetna of WY Medicare |
$920.96
|
| Rate for Payer: Altius Commercial |
$1,381.44
|
| Rate for Payer: Beech Street Commercial |
$1,410.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.83
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,395.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,410.22
|
| Rate for Payer: Entrust Commercial |
$1,367.05
|
| Rate for Payer: First Choice Health Commercial |
$1,367.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,367.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$877.79
|
| Rate for Payer: HealthUtah PPO |
$1,439.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,395.83
|
| Rate for Payer: Multiplan Medicare/VA |
$833.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,410.22
|
| Rate for Payer: PacificSource Commercial |
$1,295.10
|
| Rate for Payer: PHCS PPO |
$1,410.22
|
| Rate for Payer: Three Rivers PPO |
$1,079.25
|
| Rate for Payer: TriWest Veterans Administration |
$877.79
|
| Rate for Payer: United Healthcare Commercial |
$1,374.24
|
| Rate for Payer: United Healthcare Medicare |
$877.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,367.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,367.05
|
|
|
HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$887.88
|
| Rate for Payer: Aetna of WY Medicare |
$597.96
|
| Rate for Payer: Altius Commercial |
$869.76
|
| Rate for Payer: Beech Street Commercial |
$887.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$878.82
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$878.82
|
| Rate for Payer: Cigna of WY Commercial |
$887.88
|
| Rate for Payer: Entrust Commercial |
$860.70
|
| Rate for Payer: First Choice Health Commercial |
$860.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$860.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$516.42
|
| Rate for Payer: HealthUtah PPO |
$906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$878.82
|
| Rate for Payer: Multiplan Medicare/VA |
$490.60
|
| Rate for Payer: One Health Plan of WY PPO |
$887.88
|
| Rate for Payer: PacificSource Commercial |
$815.40
|
| Rate for Payer: PHCS PPO |
$887.88
|
| Rate for Payer: Three Rivers PPO |
$679.50
|
| Rate for Payer: TriWest Veterans Administration |
$516.42
|
| Rate for Payer: United Healthcare Commercial |
$865.23
|
| Rate for Payer: United Healthcare Medicare |
$516.42
|
| Rate for Payer: WINHealth Partners Commercial |
$887.88
|
| Rate for Payer: Wise Provider Network Commercial |
$860.70
|
|
|
HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$525.03 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$887.88
|
| Rate for Payer: Aetna of WY Medicare |
$579.84
|
| Rate for Payer: Altius Commercial |
$869.76
|
| Rate for Payer: Beech Street Commercial |
$887.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$878.82
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$878.82
|
| Rate for Payer: Cigna of WY Commercial |
$887.88
|
| Rate for Payer: Entrust Commercial |
$860.70
|
| Rate for Payer: First Choice Health Commercial |
$860.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$860.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$552.66
|
| Rate for Payer: HealthUtah PPO |
$906.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$878.82
|
| Rate for Payer: Multiplan Medicare/VA |
$525.03
|
| Rate for Payer: One Health Plan of WY PPO |
$887.88
|
| Rate for Payer: PacificSource Commercial |
$815.40
|
| Rate for Payer: PHCS PPO |
$887.88
|
| Rate for Payer: Three Rivers PPO |
$679.50
|
| Rate for Payer: TriWest Veterans Administration |
$552.66
|
| Rate for Payer: United Healthcare Commercial |
$865.23
|
| Rate for Payer: United Healthcare Medicare |
$552.66
|
| Rate for Payer: WINHealth Partners Commercial |
$860.70
|
| Rate for Payer: Wise Provider Network Commercial |
$860.70
|
|
|
HC CARDIAC STRESS TST XERS&/OR RX CONT ECG I&R ONLY
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
5109301801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Medicare |
$42.24
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.26
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$38.25
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.26
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
| Rate for Payer: United Healthcare Medicare |
$40.26
|
| Rate for Payer: WINHealth Partners Commercial |
$62.70
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC CARDIAC STRESS TST XERS&/OR RX CONT ECG I&R ONLY
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
5109301801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Medicare |
$43.56
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.62
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$35.74
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.62
|
| Rate for Payer: United Healthcare Commercial |
$63.03
|
| Rate for Payer: United Healthcare Medicare |
$37.62
|
| Rate for Payer: WINHealth Partners Commercial |
$64.68
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$110.08
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.84
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.92
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$99.67
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.92
|
| Rate for Payer: United Healthcare Commercial |
$164.26
|
| Rate for Payer: United Healthcare Medicare |
$104.92
|
| Rate for Payer: WINHealth Partners Commercial |
$163.40
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.14 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$113.52
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.84
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.04
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$93.14
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$98.04
|
| Rate for Payer: United Healthcare Commercial |
$164.26
|
| Rate for Payer: United Healthcare Medicare |
$98.04
|
| Rate for Payer: WINHealth Partners Commercial |
$168.56
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$142.41 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$257.74
|
| Rate for Payer: Aetna of WY Medicare |
$173.58
|
| Rate for Payer: Altius Commercial |
$252.48
|
| Rate for Payer: Beech Street Commercial |
$257.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$255.11
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$255.11
|
| Rate for Payer: Cigna of WY Commercial |
$257.74
|
| Rate for Payer: Entrust Commercial |
$249.85
|
| Rate for Payer: First Choice Health Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.91
|
| Rate for Payer: HealthUtah PPO |
$263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$255.11
|
| Rate for Payer: Multiplan Medicare/VA |
$142.41
|
| Rate for Payer: One Health Plan of WY PPO |
$257.74
|
| Rate for Payer: PacificSource Commercial |
$236.70
|
| Rate for Payer: PHCS PPO |
$257.74
|
| Rate for Payer: Three Rivers PPO |
$197.25
|
| Rate for Payer: TriWest Veterans Administration |
$149.91
|
| Rate for Payer: United Healthcare Commercial |
$251.16
|
| Rate for Payer: United Healthcare Medicare |
$149.91
|
| Rate for Payer: WINHealth Partners Commercial |
$257.74
|
| Rate for Payer: Wise Provider Network Commercial |
$249.85
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$257.74
|
| Rate for Payer: Aetna of WY Medicare |
$168.32
|
| Rate for Payer: Altius Commercial |
$252.48
|
| Rate for Payer: Beech Street Commercial |
$257.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$255.11
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$255.11
|
| Rate for Payer: Cigna of WY Commercial |
$257.74
|
| Rate for Payer: Entrust Commercial |
$249.85
|
| Rate for Payer: First Choice Health Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$249.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.43
|
| Rate for Payer: HealthUtah PPO |
$263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$255.11
|
| Rate for Payer: Multiplan Medicare/VA |
$152.41
|
| Rate for Payer: One Health Plan of WY PPO |
$257.74
|
| Rate for Payer: PacificSource Commercial |
$236.70
|
| Rate for Payer: PHCS PPO |
$257.74
|
| Rate for Payer: Three Rivers PPO |
$197.25
|
| Rate for Payer: TriWest Veterans Administration |
$160.43
|
| Rate for Payer: United Healthcare Commercial |
$251.16
|
| Rate for Payer: United Healthcare Medicare |
$160.43
|
| Rate for Payer: WINHealth Partners Commercial |
$249.85
|
| Rate for Payer: Wise Provider Network Commercial |
$249.85
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$157.44
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.62
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.06
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$142.56
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$150.06
|
| Rate for Payer: United Healthcare Commercial |
$234.93
|
| Rate for Payer: United Healthcare Medicare |
$150.06
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.62
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.22
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$133.21
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$234.93
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$157.44
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.62
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.06
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$142.56
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$150.06
|
| Rate for Payer: United Healthcare Commercial |
$234.93
|
| Rate for Payer: United Healthcare Medicare |
$150.06
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
3028614704
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.62
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.22
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$133.21
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.22
|
| Rate for Payer: United Healthcare Commercial |
$234.93
|
| Rate for Payer: United Healthcare Medicare |
$140.22
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CARDIOVERSION, ELECTIVE;EXTERN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4819296001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
