|
HC LYMPH CHORIOMENINGITIS - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86727
|
| Hospital Charge Code |
3028672701
|
|
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 LYMPH CHORIOMENINGITIS - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86727
|
| Hospital Charge Code |
3028672701
|
|
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 LYMPHOCYTE TRANSFORMATION - LYMPHOCYTE CULTURE, PRIMED
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
3028635301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Aetna of WY Medicare |
$448.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.40
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$374.68
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$394.40
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$394.40
|
| Rate for Payer: WINHealth Partners Commercial |
$666.40
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC LYMPHOCYTE TRANSFORMATION - LYMPHOCYTE CULTURE, PRIMED
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 86353
|
| Hospital Charge Code |
3028635301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.80
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$426.36
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$448.80
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$448.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
5105416201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.75 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Aetna of WY Medicare |
$132.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.96
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.02
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.58
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$110.75
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$116.58
|
| Rate for Payer: United Healthcare Commercial |
$174.87
|
| Rate for Payer: United Healthcare Medicare |
$116.58
|
| Rate for Payer: WINHealth Partners Commercial |
$196.98
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
5105416201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.96
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.02
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.66
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$126.03
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.66
|
| Rate for Payer: United Healthcare Commercial |
$174.87
|
| Rate for Payer: United Healthcare Medicare |
$132.66
|
| Rate for Payer: WINHealth Partners Commercial |
$190.95
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC MALARIAL/PARASITE SMEAR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC MALARIAL/PARASITE SMEAR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC MAMMO SCREENING PROMO CODE
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706709
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC MAMMO SCREENING PROMO CODE
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706709
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$125.31
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 26341
|
| Hospital Charge Code |
5102634101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.41 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.38
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$246.41
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$259.38
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$259.38
|
| Rate for Payer: WINHealth Partners Commercial |
$373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 26341
|
| Hospital Charge Code |
5102634101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.54 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$259.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.94
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$216.54
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.94
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$227.94
|
| Rate for Payer: WINHealth Partners Commercial |
$385.14
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
5105644001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
5105644001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - 24 HOUR URINE CORTISONE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - 24 HOUR URINE CORTISONE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378907
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - IODIDE SERUM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - IODIDE SERUM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - IODIDE URINE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - IODIDE URINE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - LEUKOTRIENE E4
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - LEUKOTRIENE E4
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - SILVER LEVEL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - SILVER LEVEL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - THIOPURINE METABOLITES
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
