|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
3028630001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 15-3
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
3028630001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
3028630002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
3028630002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, QUAL - BLADDER TUMOR MARKER
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86294
|
| Hospital Charge Code |
3028629402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, QUAL - BLADDER TUMOR MARKER
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86294
|
| Hospital Charge Code |
3028629402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC IMMUNODIFFUSION NES
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 86329
|
| Hospital Charge Code |
3028632901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.70
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$128.70
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC IMMUNODIFFUSION NES
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 86329
|
| Hospital Charge Code |
3028632901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.10
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$107.44
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$113.10
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC IMMUNOELECTROPHORESIS SERUM
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
3028632001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$376.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$376.20
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
| Rate for Payer: WINHealth Partners Commercial |
$570.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC IMMUNOELECTROPHORESIS SERUM
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 86320
|
| Hospital Charge Code |
3028632001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$396.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$330.60
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$348.00
|
| Rate for Payer: WINHealth Partners Commercial |
$588.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC IMMUNOFIXATION ELECTROPHORESIS SERUM
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| 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 IMMUNOFIXATION ELECTROPHORESIS SERUM
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| 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 IMMUNOFLUORESCENT STUDY,INDIRECT - EPITHELIAL CELL SURG AB IGG
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
3128834602
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,254.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,191.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,254.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,254.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC IMMUNOFLUORESCENT STUDY,INDIRECT - EPITHELIAL CELL SURG AB IGG
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 88346
|
| Hospital Charge Code |
3128834602
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,046.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,254.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,046.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,102.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,862.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC IMMUNOGLOBULIN ASSAY - PLATELET ANTIBODIES, DIRECT
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 86023
|
| Hospital Charge Code |
3028602301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC IMMUNOGLOBULIN ASSAY - PLATELET ANTIBODIES, DIRECT
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 86023
|
| Hospital Charge Code |
3028602301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$760.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834104
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$529.82 |
| Max. Negotiated Rate |
$845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$811.20
|
| Rate for Payer: Altius Commercial |
$811.20
|
| Rate for Payer: Beech Street Commercial |
$828.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$693.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.65
|
| Rate for Payer: Cigna of WY Commercial |
$828.10
|
| Rate for Payer: Entrust Commercial |
$802.75
|
| Rate for Payer: First Choice Health Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$557.70
|
| Rate for Payer: HealthUtah PPO |
$845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.65
|
| Rate for Payer: Multiplan Medicare/VA |
$529.82
|
| Rate for Payer: One Health Plan of WY PPO |
$828.10
|
| Rate for Payer: PacificSource Commercial |
$760.50
|
| Rate for Payer: PHCS PPO |
$828.10
|
| Rate for Payer: Three Rivers PPO |
$633.75
|
| Rate for Payer: TriWest Veterans Administration |
$557.70
|
| Rate for Payer: United Healthcare Commercial |
$735.15
|
| Rate for Payer: United Healthcare Medicare |
$557.70
|
| Rate for Payer: WINHealth Partners Commercial |
$802.75
|
| Rate for Payer: Wise Provider Network Commercial |
$802.75
|
|
|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834104
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.10
|
| Rate for Payer: Aetna of WY Medicare |
$557.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$811.20
|
| Rate for Payer: Altius Commercial |
$811.20
|
| Rate for Payer: Beech Street Commercial |
$828.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$693.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.65
|
| Rate for Payer: Cigna of WY Commercial |
$828.10
|
| Rate for Payer: Entrust Commercial |
$802.75
|
| Rate for Payer: First Choice Health Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$490.10
|
| Rate for Payer: HealthUtah PPO |
$845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.65
|
| Rate for Payer: Multiplan Medicare/VA |
$465.60
|
| Rate for Payer: One Health Plan of WY PPO |
$828.10
|
| Rate for Payer: PacificSource Commercial |
$760.50
|
| Rate for Payer: PHCS PPO |
$828.10
|
| Rate for Payer: Three Rivers PPO |
$633.75
|
| Rate for Payer: TriWest Veterans Administration |
$490.10
|
| Rate for Payer: United Healthcare Commercial |
$735.15
|
| Rate for Payer: United Healthcare Medicare |
$490.10
|
| Rate for Payer: WINHealth Partners Commercial |
$828.10
|
| Rate for Payer: Wise Provider Network Commercial |
$802.75
|
|
