|
HC MUCOPOLYSACCHARIDES - MUCOPOLYSACCHARIDES SCREEN
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 83864
|
| Hospital Charge Code |
3018386401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
OP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
7409580501
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,922.99 |
| Max. Negotiated Rate |
$3,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,420.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,303.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,350.40
|
| Rate for Payer: Altius Commercial |
$3,350.40
|
| Rate for Payer: Beech Street Commercial |
$3,420.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,865.29
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,385.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,420.20
|
| Rate for Payer: Entrust Commercial |
$3,315.50
|
| Rate for Payer: First Choice Health Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,024.20
|
| Rate for Payer: HealthUtah PPO |
$3,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,385.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,922.99
|
| Rate for Payer: One Health Plan of WY PPO |
$3,420.20
|
| Rate for Payer: PacificSource Commercial |
$3,141.00
|
| Rate for Payer: PHCS PPO |
$3,420.20
|
| Rate for Payer: Three Rivers PPO |
$2,617.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,024.20
|
| Rate for Payer: United Healthcare Commercial |
$3,036.30
|
| Rate for Payer: United Healthcare Medicare |
$2,024.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,420.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,315.50
|
|
|
HC MULTIPLE SLEEP LATENCY TEST
|
Facility
|
IP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
7409580501
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,188.23 |
| Max. Negotiated Rate |
$3,490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,420.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,350.40
|
| Rate for Payer: Altius Commercial |
$3,350.40
|
| Rate for Payer: Beech Street Commercial |
$3,420.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,865.29
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,385.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,420.20
|
| Rate for Payer: Entrust Commercial |
$3,315.50
|
| Rate for Payer: First Choice Health Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,315.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,303.40
|
| Rate for Payer: HealthUtah PPO |
$3,490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,385.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2,188.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,420.20
|
| Rate for Payer: PacificSource Commercial |
$3,141.00
|
| Rate for Payer: PHCS PPO |
$3,420.20
|
| Rate for Payer: Three Rivers PPO |
$2,617.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,303.40
|
| Rate for Payer: United Healthcare Commercial |
$3,036.30
|
| Rate for Payer: United Healthcare Medicare |
$2,303.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,315.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,315.50
|
|
|
HC MUMPS - MUMPS IGG ANTIBODY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC MUMPS - MUMPS IGG ANTIBODY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| 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 MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| 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 MURAMIDASE - LYSOZYME, SERUM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3058554901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC MURAMIDASE - LYSOZYME, SERUM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3058554901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC MURAMIDASE - LYSOZYME, URINE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3058554902
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC MURAMIDASE - LYSOZYME, URINE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3058554902
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
3028673802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
3028673802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
3028673801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
3028673801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
3018387301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
3018387301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
3206230401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,598.85 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,499.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,448.00
|
| Rate for Payer: Altius Commercial |
$2,448.00
|
| Rate for Payer: Beech Street Commercial |
$2,499.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,093.55
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,473.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,499.00
|
| Rate for Payer: Entrust Commercial |
$2,422.50
|
| Rate for Payer: First Choice Health Commercial |
$2,422.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,422.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,683.00
|
| Rate for Payer: HealthUtah PPO |
$2,550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,473.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,598.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,499.00
|
| Rate for Payer: PacificSource Commercial |
$2,295.00
|
| Rate for Payer: PHCS PPO |
$2,499.00
|
| Rate for Payer: Three Rivers PPO |
$1,912.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare Medicare |
$1,683.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,422.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,422.50
|
|
|
HC MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
3206230401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,405.05 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,499.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,683.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,448.00
|
| Rate for Payer: Altius Commercial |
$2,448.00
|
| Rate for Payer: Beech Street Commercial |
$2,499.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,093.55
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,473.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,499.00
|
| Rate for Payer: Entrust Commercial |
$2,422.50
|
| Rate for Payer: First Choice Health Commercial |
$2,422.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,422.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,479.00
|
| Rate for Payer: HealthUtah PPO |
$2,550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,473.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,405.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,499.00
|
| Rate for Payer: PacificSource Commercial |
$2,295.00
|
| Rate for Payer: PHCS PPO |
$2,499.00
|
| Rate for Payer: Three Rivers PPO |
$1,912.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,479.00
|
| Rate for Payer: United Healthcare Commercial |
$2,218.50
|
| Rate for Payer: United Healthcare Medicare |
$1,479.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,499.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,422.50
|
|
|
HC MYRINGOTOM W ASPIRATION/EUSTACHIAN TUBE INFLATION
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
5106942001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$500.31 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Aetna of WY Medicare |
$599.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$871.68
|
| Rate for Payer: Altius Commercial |
$871.68
|
| Rate for Payer: Beech Street Commercial |
$889.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$745.47
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: Entrust Commercial |
$862.60
|
| Rate for Payer: First Choice Health Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.64
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$500.31
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$889.84
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$526.64
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$526.64
|
| Rate for Payer: WINHealth Partners Commercial |
$889.84
|
| Rate for Payer: Wise Provider Network Commercial |
$862.60
|
|
|
HC MYRINGOTOM W ASPIRATION/EUSTACHIAN TUBE INFLATION
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
5106942001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$569.32 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$889.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$871.68
|
| Rate for Payer: Altius Commercial |
$871.68
|
| Rate for Payer: Beech Street Commercial |
$889.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$745.47
|
| Rate for Payer: Cash Price |
$635.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$880.76
|
| Rate for Payer: Cigna of WY Commercial |
$889.84
|
| Rate for Payer: Entrust Commercial |
$862.60
|
| Rate for Payer: First Choice Health Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$599.28
|
| Rate for Payer: HealthUtah PPO |
$908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$880.76
|
| Rate for Payer: Multiplan Medicare/VA |
$569.32
|
| Rate for Payer: One Health Plan of WY PPO |
$889.84
|
| Rate for Payer: PacificSource Commercial |
$817.20
|
| Rate for Payer: PHCS PPO |
$889.84
|
| Rate for Payer: Three Rivers PPO |
$681.00
|
| Rate for Payer: TriWest Veterans Administration |
$599.28
|
| Rate for Payer: United Healthcare Commercial |
$789.96
|
| Rate for Payer: United Healthcare Medicare |
$599.28
|
| Rate for Payer: WINHealth Partners Commercial |
$862.60
|
| Rate for Payer: Wise Provider Network Commercial |
$862.60
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
5103123101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.66
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$94.68
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.66
|
| Rate for Payer: United Healthcare Commercial |
$131.37
|
| Rate for Payer: United Healthcare Medicare |
$99.66
|
| Rate for Payer: WINHealth Partners Commercial |
$143.45
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
5103123101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Aetna of WY Medicare |
$99.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.58
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$83.20
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$87.58
|
| Rate for Payer: United Healthcare Commercial |
$131.37
|
| Rate for Payer: United Healthcare Medicare |
$87.58
|
| Rate for Payer: WINHealth Partners Commercial |
$147.98
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC NASAL SMEAR FOR EOSINOPHILS - EOSINOPHIL SMEAR
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3008919001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.04
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.94
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.04
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$22.04
|
| Rate for Payer: WINHealth Partners Commercial |
$37.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC NASAL SMEAR FOR EOSINOPHILS - EOSINOPHIL SMEAR
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3008919001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
