|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$166.40
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$150.67
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.60
|
| Rate for Payer: United Healthcare Commercial |
$248.30
|
| Rate for Payer: United Healthcare Medicare |
$158.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530601
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.20
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$140.79
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.20
|
| Rate for Payer: United Healthcare Commercial |
$248.30
|
| Rate for Payer: United Healthcare Medicare |
$148.20
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.20
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$140.79
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.20
|
| Rate for Payer: United Healthcare Commercial |
$248.30
|
| Rate for Payer: United Healthcare Medicare |
$148.20
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
3058530602
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$166.40
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$150.67
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.60
|
| Rate for Payer: United Healthcare Commercial |
$248.30
|
| Rate for Payer: United Healthcare Medicare |
$158.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC CMV ANTIBODY - CYTOMEGALOVIRUS IGG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3028664401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.92
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$84.47
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.92
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$88.92
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC CMV ANTIBODY - CYTOMEGALOVIRUS IGG
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
3028664401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$99.84
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.16
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$90.40
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.16
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$95.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$172.16
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.09
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$155.89
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$164.09
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$164.09
|
| Rate for Payer: WINHealth Partners Commercial |
$255.55
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 86645 90
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$123.52
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.73
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$111.84
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$117.73
|
| Rate for Payer: WINHealth Partners Commercial |
$183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 86645 90
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$127.38
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.01
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$104.51
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$110.01
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$110.01
|
| Rate for Payer: WINHealth Partners Commercial |
$189.14
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CMV ANTIBODY, IGM - CMV IGM
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$177.54
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.33
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$145.66
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.33
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$153.33
|
| Rate for Payer: WINHealth Partners Commercial |
$263.62
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$123.52
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.73
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$111.84
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$117.73
|
| Rate for Payer: WINHealth Partners Commercial |
$183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
3028664502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$127.38
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.01
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$104.51
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$110.01
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$110.01
|
| Rate for Payer: WINHealth Partners Commercial |
$189.14
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CNTRL NASAL HEMORRHA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
7613090601
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
HC CNTRL NASAL HEMORRHA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
7613090601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| 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 |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| 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 |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CNTRL OROPHARYNGEAL HEM
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
7614296201
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
HC CNTRL OROPHARYNGEAL HEM
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
7614296201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| 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 |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| 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 |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES COMPLEMENT FIXATION
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$135.92 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$165.66
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.47
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.07
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$135.92
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.07
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
| Rate for Payer: United Healthcare Medicare |
$143.07
|
| Rate for Payer: WINHealth Partners Commercial |
$245.98
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES COMPLEMENT FIXATION
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$160.64
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.47
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.11
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$145.45
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$153.11
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
| Rate for Payer: United Healthcare Medicare |
$153.11
|
| Rate for Payer: WINHealth Partners Commercial |
$238.45
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGG
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGG
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGM
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGM
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IMMUNODIFFUSION
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$135.92 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$165.66
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.47
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.07
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$135.92
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.07
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
| Rate for Payer: United Healthcare Medicare |
$143.07
|
| Rate for Payer: WINHealth Partners Commercial |
$245.98
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IMMUNODIFFUSION
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.98
|
| Rate for Payer: Aetna of WY Medicare |
$160.64
|
| Rate for Payer: Altius Commercial |
$240.96
|
| Rate for Payer: Beech Street Commercial |
$245.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.47
|
| Rate for Payer: Cash Price |
$175.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.47
|
| Rate for Payer: Cigna of WY Commercial |
$245.98
|
| Rate for Payer: Entrust Commercial |
$238.45
|
| Rate for Payer: First Choice Health Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.11
|
| Rate for Payer: HealthUtah PPO |
$251.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.47
|
| Rate for Payer: Multiplan Medicare/VA |
$145.45
|
| Rate for Payer: One Health Plan of WY PPO |
$245.98
|
| Rate for Payer: PacificSource Commercial |
$225.90
|
| Rate for Payer: PHCS PPO |
$245.98
|
| Rate for Payer: Three Rivers PPO |
$188.25
|
| Rate for Payer: TriWest Veterans Administration |
$153.11
|
| Rate for Payer: United Healthcare Commercial |
$239.70
|
| Rate for Payer: United Healthcare Medicare |
$153.11
|
| Rate for Payer: WINHealth Partners Commercial |
$238.45
|
| Rate for Payer: Wise Provider Network Commercial |
$238.45
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$122.24
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.27
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.51
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$110.68
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$116.51
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
| Rate for Payer: United Healthcare Medicare |
$116.51
|
| Rate for Payer: WINHealth Partners Commercial |
$181.45
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
