|
HC MASS SPECTROMETRY QUAL/QUAN NONDRUG ANALYTE - THIOPURINE METABOLITES
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| 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 |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| 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 |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$341.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$221.48
|
| Rate for Payer: Aetna of WY Medicare |
$229.68
|
| Rate for Payer: Aetna of WY Medicare |
$149.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$334.08
|
| Rate for Payer: Altius Commercial |
$334.08
|
| Rate for Payer: Altius Commercial |
$216.96
|
| Rate for Payer: Beech Street Commercial |
$221.48
|
| Rate for Payer: Beech Street Commercial |
$341.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.55
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$337.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$219.22
|
| Rate for Payer: Cigna of WY Commercial |
$221.48
|
| Rate for Payer: Cigna of WY Commercial |
$341.04
|
| Rate for Payer: Entrust Commercial |
$330.60
|
| Rate for Payer: Entrust Commercial |
$214.70
|
| Rate for Payer: First Choice Health Commercial |
$214.70
|
| Rate for Payer: First Choice Health Commercial |
$330.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$330.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.08
|
| Rate for Payer: HealthUtah PPO |
$226.00
|
| Rate for Payer: HealthUtah PPO |
$348.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$219.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$337.56
|
| Rate for Payer: Multiplan Medicare/VA |
$191.75
|
| Rate for Payer: Multiplan Medicare/VA |
$124.53
|
| Rate for Payer: One Health Plan of WY PPO |
$221.48
|
| Rate for Payer: One Health Plan of WY PPO |
$341.04
|
| Rate for Payer: PacificSource Commercial |
$313.20
|
| Rate for Payer: PacificSource Commercial |
$203.40
|
| Rate for Payer: PHCS PPO |
$221.48
|
| Rate for Payer: PHCS PPO |
$341.04
|
| Rate for Payer: Three Rivers PPO |
$169.50
|
| Rate for Payer: Three Rivers PPO |
$261.00
|
| Rate for Payer: TriWest Veterans Administration |
$201.84
|
| Rate for Payer: TriWest Veterans Administration |
$131.08
|
| Rate for Payer: United Healthcare Commercial |
$196.62
|
| Rate for Payer: United Healthcare Commercial |
$302.76
|
| Rate for Payer: United Healthcare Medicare |
$201.84
|
| Rate for Payer: United Healthcare Medicare |
$131.08
|
| Rate for Payer: WINHealth Partners Commercial |
$221.48
|
| Rate for Payer: WINHealth Partners Commercial |
$341.04
|
| Rate for Payer: Wise Provider Network Commercial |
$214.70
|
| Rate for Payer: Wise Provider Network Commercial |
$330.60
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.20 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$341.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$221.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$334.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.96
|
| Rate for Payer: Altius Commercial |
$216.96
|
| Rate for Payer: Altius Commercial |
$334.08
|
| Rate for Payer: Beech Street Commercial |
$341.04
|
| Rate for Payer: Beech Street Commercial |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.71
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$219.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$337.56
|
| Rate for Payer: Cigna of WY Commercial |
$341.04
|
| Rate for Payer: Cigna of WY Commercial |
$221.48
|
| Rate for Payer: Entrust Commercial |
$214.70
|
| Rate for Payer: Entrust Commercial |
$330.60
|
| Rate for Payer: First Choice Health Commercial |
$214.70
|
| Rate for Payer: First Choice Health Commercial |
$330.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$330.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.16
|
| Rate for Payer: HealthUtah PPO |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$226.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$219.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$337.56
|
| Rate for Payer: Multiplan Medicare/VA |
$218.20
|
| Rate for Payer: Multiplan Medicare/VA |
$141.70
|
| Rate for Payer: One Health Plan of WY PPO |
$341.04
|
| Rate for Payer: One Health Plan of WY PPO |
$221.48
|
| Rate for Payer: PacificSource Commercial |
$313.20
|
| Rate for Payer: PacificSource Commercial |
$203.40
|
| Rate for Payer: PHCS PPO |
$221.48
|
| Rate for Payer: PHCS PPO |
$341.04
|
| Rate for Payer: Three Rivers PPO |
$169.50
|
| Rate for Payer: Three Rivers PPO |
$261.00
|
| Rate for Payer: TriWest Veterans Administration |
$229.68
|
| Rate for Payer: TriWest Veterans Administration |
$149.16
|
| Rate for Payer: United Healthcare Commercial |
$196.62
|
| Rate for Payer: United Healthcare Commercial |
$302.76
|
| Rate for Payer: United Healthcare Medicare |
$229.68
|
| Rate for Payer: United Healthcare Medicare |
$149.16
|
| Rate for Payer: WINHealth Partners Commercial |
$214.70
|
| Rate for Payer: WINHealth Partners Commercial |
$330.60
|
| Rate for Payer: Wise Provider Network Commercial |
$214.70
|
| Rate for Payer: Wise Provider Network Commercial |
$330.60
|
|
|
HC MEASURE POST VOID RES URINE/CAPACITY US
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
5105179801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$29.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.10
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$24.80
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
| Rate for Payer: WINHealth Partners Commercial |
$44.10
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC MEASURE POST VOID RES URINE/CAPACITY US
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
5105179801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.70
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$28.22
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$29.70
|
| Rate for Payer: WINHealth Partners Commercial |
$42.75
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC MEDICAL NUTRITION THERAPY REAS SAME YR INDIV EA 15 MN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
942G027001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC MEDICAL NUTRITION THERAPY REAS SAME YR INDIV EA 15 MN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS G0270
|
| Hospital Charge Code |
942G027001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC MEDICAL NUTRITION THERAPY REAS SAM YR GROUP EA 30 MIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
942G027101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC MEDICAL NUTRITION THERAPY REAS SAM YR GROUP EA 30 MIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
942G027101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC MED NUTR THER, 1ST, INDIV, EA 15 MIN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
9429780201
|
|
Hospital Revenue Code
|
942
|
| 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 MED NUTR THER, 1ST, INDIV, EA 15 MIN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
9429780201
|
|
Hospital Revenue Code
|
942
|
| 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 MED NUTR THER, GROUP, EA 30 MIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
9429780401
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC MED NUTR THER, GROUP, EA 30 MIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
9429780401
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
9429780301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
9429780301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| 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 METABOLIC PANEL,COMPREHENSIVE
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| 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 MICOBACTERIA CULTURE TB/AFB
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
3068711601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$311.32 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Aetna of WY Medicare |
$372.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.70
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$311.32
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$327.70
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$327.70
|
| Rate for Payer: WINHealth Partners Commercial |
$553.70
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
|
HC MICOBACTERIA CULTURE TB/AFB
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
3068711601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$553.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$542.40
|
| Rate for Payer: Altius Commercial |
$542.40
|
| Rate for Payer: Beech Street Commercial |
$553.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$463.86
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$548.05
|
| Rate for Payer: Cigna of WY Commercial |
$553.70
|
| Rate for Payer: Entrust Commercial |
$536.75
|
| Rate for Payer: First Choice Health Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$536.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.90
|
| Rate for Payer: HealthUtah PPO |
$565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$548.05
|
| Rate for Payer: Multiplan Medicare/VA |
$354.26
|
| Rate for Payer: One Health Plan of WY PPO |
$553.70
|
| Rate for Payer: PacificSource Commercial |
$508.50
|
| Rate for Payer: PHCS PPO |
$553.70
|
| Rate for Payer: Three Rivers PPO |
$423.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.90
|
| Rate for Payer: United Healthcare Commercial |
$491.55
|
| Rate for Payer: United Healthcare Medicare |
$372.90
|
| Rate for Payer: WINHealth Partners Commercial |
$536.75
|
| Rate for Payer: Wise Provider Network Commercial |
$536.75
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204302
|
|
Hospital Revenue Code
|
301
|
| 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 MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204302
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
