|
HC IMM ADMIN <19YRS W MD/PA/NP COUNSEL, EA ADD'L INJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC IMM ADMIN <19YRS W MD/PA/NP COUNSEL, EA ADD'L INJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC IMM ADMIN <19YRS W MD/PA/NP COUNSEL, EA ADD'L INJ - VFC
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC IMM ADMIN <19YRS W MD/PA/NP COUNSEL, EA ADD'L INJ - VFC
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
HC IMMUNE COMPLEX ASSAY
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
3008633201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC IMMUNE COMPLEX ASSAY
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 86332
|
| Hospital Charge Code |
3008633201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - BETA 2 TRANSFERRIN
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3028633501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - BETA 2 TRANSFERRIN
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3028633501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3028633502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3028633502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.40
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$150.48
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$158.40
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$158.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.20
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$132.24
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: WINHealth Partners Commercial |
$235.20
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID CHILDREN
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.40
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$150.48
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$158.40
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID CHILDREN
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$158.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.20
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$132.24
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: WINHealth Partners Commercial |
$235.20
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.52
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.42
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$23.20
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$24.42
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$24.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.52
|
| Rate for Payer: Altius Commercial |
$35.52
|
| Rate for Payer: Beech Street Commercial |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: Entrust Commercial |
$35.15
|
| Rate for Payer: First Choice Health Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.46
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$20.39
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$36.26
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.46
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$21.46
|
| Rate for Payer: WINHealth Partners Commercial |
$36.26
|
| Rate for Payer: Wise Provider Network Commercial |
$35.15
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
IP
|
$21.72
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.85
|
| Rate for Payer: Altius Commercial |
$20.85
|
| Rate for Payer: Beech Street Commercial |
$21.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.83
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.07
|
| Rate for Payer: Cigna of WY Commercial |
$21.29
|
| Rate for Payer: Entrust Commercial |
$20.63
|
| Rate for Payer: First Choice Health Commercial |
$20.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.34
|
| Rate for Payer: HealthUtah PPO |
$21.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.07
|
| Rate for Payer: Multiplan Medicare/VA |
$13.62
|
| Rate for Payer: One Health Plan of WY PPO |
$21.29
|
| Rate for Payer: PacificSource Commercial |
$19.55
|
| Rate for Payer: PHCS PPO |
$21.29
|
| Rate for Payer: Three Rivers PPO |
$16.29
|
| Rate for Payer: TriWest Veterans Administration |
$14.34
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare |
$14.34
|
| Rate for Payer: WINHealth Partners Commercial |
$20.63
|
| Rate for Payer: Wise Provider Network Commercial |
$20.63
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
OP
|
$21.72
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.29
|
| Rate for Payer: Aetna of WY Medicare |
$14.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.85
|
| Rate for Payer: Altius Commercial |
$20.85
|
| Rate for Payer: Beech Street Commercial |
$21.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.83
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.07
|
| Rate for Payer: Cigna of WY Commercial |
$21.29
|
| Rate for Payer: Entrust Commercial |
$20.63
|
| Rate for Payer: First Choice Health Commercial |
$20.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.60
|
| Rate for Payer: HealthUtah PPO |
$21.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.07
|
| Rate for Payer: Multiplan Medicare/VA |
$11.97
|
| Rate for Payer: One Health Plan of WY PPO |
$21.29
|
| Rate for Payer: PacificSource Commercial |
$19.55
|
| Rate for Payer: PHCS PPO |
$21.29
|
| Rate for Payer: Three Rivers PPO |
$16.29
|
| Rate for Payer: TriWest Veterans Administration |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare |
$12.60
|
| Rate for Payer: WINHealth Partners Commercial |
$21.29
|
| Rate for Payer: Wise Provider Network Commercial |
$20.63
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$247.04 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$386.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$378.24
|
| Rate for Payer: Altius Commercial |
$378.24
|
| Rate for Payer: Beech Street Commercial |
$386.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$323.47
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$382.18
|
| Rate for Payer: Cigna of WY Commercial |
$386.12
|
| Rate for Payer: Entrust Commercial |
$374.30
|
| Rate for Payer: First Choice Health Commercial |
$374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.04
|
| Rate for Payer: HealthUtah PPO |
$394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$382.18
|
| Rate for Payer: Multiplan Medicare/VA |
$247.04
|
| Rate for Payer: One Health Plan of WY PPO |
$386.12
|
| Rate for Payer: PacificSource Commercial |
$354.60
|
| Rate for Payer: PHCS PPO |
$386.12
|
| Rate for Payer: Three Rivers PPO |
$295.50
|
| Rate for Payer: TriWest Veterans Administration |
$260.04
|
| Rate for Payer: United Healthcare Commercial |
$342.78
|
| Rate for Payer: United Healthcare Medicare |
$260.04
|
| Rate for Payer: WINHealth Partners Commercial |
$374.30
|
| Rate for Payer: Wise Provider Network Commercial |
$374.30
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$386.12
|
| Rate for Payer: Aetna of WY Medicare |
$260.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$378.24
|
| Rate for Payer: Altius Commercial |
$378.24
|
| Rate for Payer: Beech Street Commercial |
$386.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$323.47
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$382.18
|
| Rate for Payer: Cigna of WY Commercial |
$386.12
|
| Rate for Payer: Entrust Commercial |
$374.30
|
| Rate for Payer: First Choice Health Commercial |
$374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$374.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.52
|
| Rate for Payer: HealthUtah PPO |
$394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$382.18
|
| Rate for Payer: Multiplan Medicare/VA |
$217.09
|
| Rate for Payer: One Health Plan of WY PPO |
$386.12
|
| Rate for Payer: PacificSource Commercial |
$354.60
|
| Rate for Payer: PHCS PPO |
$386.12
|
| Rate for Payer: Three Rivers PPO |
$295.50
|
| Rate for Payer: TriWest Veterans Administration |
$228.52
|
| Rate for Payer: United Healthcare Commercial |
$342.78
|
| Rate for Payer: United Healthcare Medicare |
$228.52
|
| Rate for Payer: WINHealth Partners Commercial |
$386.12
|
| Rate for Payer: Wise Provider Network Commercial |
$374.30
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - ADALIMUMAB NEUTRALIZING AB
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - ADALIMUMAB NEUTRALIZING AB
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - ANTI-RNA POLYMERASE 3
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - ANTI-RNA POLYMERASE 3
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS - GANGLIOSIDE GQ1B IGG ANTIBODY
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
3018352016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
