|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC NM CARDIOLITE 40 CONTRAST
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$944.96 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,131.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,646.40
|
| Rate for Payer: Altius Commercial |
$1,646.40
|
| Rate for Payer: Beech Street Commercial |
$1,680.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,408.02
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: Entrust Commercial |
$1,629.25
|
| Rate for Payer: First Choice Health Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$994.70
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$944.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,680.70
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$994.70
|
| Rate for Payer: United Healthcare Commercial |
$1,492.05
|
| Rate for Payer: United Healthcare Medicare |
$994.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,680.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,629.25
|
|
|
HC NM CARDIOLITE 40 CONTRAST
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,075.30 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,646.40
|
| Rate for Payer: Altius Commercial |
$1,646.40
|
| Rate for Payer: Beech Street Commercial |
$1,680.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,408.02
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: Entrust Commercial |
$1,629.25
|
| Rate for Payer: First Choice Health Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,131.90
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,075.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,680.70
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,131.90
|
| Rate for Payer: United Healthcare Commercial |
$1,492.05
|
| Rate for Payer: United Healthcare Medicare |
$1,131.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,629.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,629.25
|
|
|
HC NM SESTAMIBI TC99
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$771.40 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Aetna of WY Medicare |
$924.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,344.00
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,149.40
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$812.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Multiplan Medicare/VA |
$771.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$812.00
|
| Rate for Payer: United Healthcare Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare Medicare |
$812.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,372.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
|
|
HC NM SESTAMIBI TC99
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$877.80 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,344.00
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,149.40
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$924.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Multiplan Medicare/VA |
$877.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare Medicare |
$924.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,330.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
|
|
HC NM WHITE BLOOD CELL
|
Facility
|
OP
|
$4,815.00
|
|
|
Service Code
|
HCPCS 78806
|
| Hospital Charge Code |
3417880602
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,653.06 |
| Max. Negotiated Rate |
$4,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,718.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,177.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,622.40
|
| Rate for Payer: Altius Commercial |
$4,622.40
|
| Rate for Payer: Beech Street Commercial |
$4,718.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,953.12
|
| Rate for Payer: Cash Price |
$3,370.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,670.55
|
| Rate for Payer: Cigna of WY Commercial |
$4,718.70
|
| Rate for Payer: Entrust Commercial |
$4,574.25
|
| Rate for Payer: First Choice Health Commercial |
$4,574.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,574.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,792.70
|
| Rate for Payer: HealthUtah PPO |
$4,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,670.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,653.06
|
| Rate for Payer: One Health Plan of WY PPO |
$4,718.70
|
| Rate for Payer: PacificSource Commercial |
$4,333.50
|
| Rate for Payer: PHCS PPO |
$4,718.70
|
| Rate for Payer: Three Rivers PPO |
$3,611.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,792.70
|
| Rate for Payer: United Healthcare Commercial |
$4,189.05
|
| Rate for Payer: United Healthcare Medicare |
$2,792.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,718.70
|
| Rate for Payer: Wise Provider Network Commercial |
$4,574.25
|
|
|
HC NM WHITE BLOOD CELL
|
Facility
|
IP
|
$4,815.00
|
|
|
Service Code
|
HCPCS 78806
|
| Hospital Charge Code |
3417880602
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,019.00 |
| Max. Negotiated Rate |
$4,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,718.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,622.40
|
| Rate for Payer: Altius Commercial |
$4,622.40
|
| Rate for Payer: Beech Street Commercial |
$4,718.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,953.12
|
| Rate for Payer: Cash Price |
$3,370.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,670.55
|
| Rate for Payer: Cigna of WY Commercial |
$4,718.70
|
| Rate for Payer: Entrust Commercial |
$4,574.25
|
| Rate for Payer: First Choice Health Commercial |
$4,574.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,574.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,177.90
|
| Rate for Payer: HealthUtah PPO |
$4,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,670.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,019.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4,718.70
|
| Rate for Payer: PacificSource Commercial |
$4,333.50
|
| Rate for Payer: PHCS PPO |
$4,718.70
|
| Rate for Payer: Three Rivers PPO |
$3,611.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,177.90
|
| Rate for Payer: United Healthcare Commercial |
$4,189.05
|
| Rate for Payer: United Healthcare Medicare |
$3,177.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,574.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,574.25
|
|
|
HC NON-HEU TC-99M ADD-ON/DOSE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
343Q996901
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC NON-HEU TC-99M ADD-ON/DOSE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
343Q996901
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC NONINVASV OXYGEN SATUR,MULTIPLE - PULSE OXIMETRY, WITH EXERCISE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4609476101
|
|
Hospital Revenue Code
|
460
|
| 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 NONINVASV OXYGEN SATUR,MULTIPLE - PULSE OXIMETRY, WITH EXERCISE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4609476101
|
|
Hospital Revenue Code
|
460
|
| 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 NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.44
|
| Rate for Payer: Altius Commercial |
$13.44
|
| Rate for Payer: Beech Street Commercial |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: Entrust Commercial |
$13.30
|
| Rate for Payer: First Choice Health Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.24
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.72
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$9.24
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
| Rate for Payer: Wise Provider Network Commercial |
$13.30
|
|
|
HC NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.44
|
| Rate for Payer: Altius Commercial |
$13.44
|
| Rate for Payer: Beech Street Commercial |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: Entrust Commercial |
$13.30
|
| Rate for Payer: First Choice Health Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.12
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$7.71
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.72
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.12
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$8.12
|
| Rate for Payer: WINHealth Partners Commercial |
$13.72
|
| Rate for Payer: Wise Provider Network Commercial |
$13.30
|
|
|
HC NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4609476201
|
|
Hospital Revenue Code
|
460
|
| 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 NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4609476201
|
|
Hospital Revenue Code
|
460
|
| 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 NONVASCULAR SHUNTOGRAM - IR NONVASCULAR SHUNTOGRAM
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
3207580901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC NONVASCULAR SHUNTOGRAM - IR NONVASCULAR SHUNTOGRAM
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
3207580901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC NUCHAL TRANSL MULT FETUS
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 76814
|
| Hospital Charge Code |
4027681401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC NUCHAL TRANSL MULT FETUS
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 76814
|
| Hospital Charge Code |
4027681401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$151.52
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$159.50
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$172.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.57 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.68
|
| Rate for Payer: Aetna of WY Medicare |
$175.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.36
|
| Rate for Payer: Altius Commercial |
$255.36
|
| Rate for Payer: Beech Street Commercial |
$260.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.39
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.02
|
| Rate for Payer: Cigna of WY Commercial |
$260.68
|
| Rate for Payer: Entrust Commercial |
$252.70
|
| Rate for Payer: First Choice Health Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.28
|
| Rate for Payer: HealthUtah PPO |
$266.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.02
|
| Rate for Payer: Multiplan Medicare/VA |
$146.57
|
| Rate for Payer: One Health Plan of WY PPO |
$260.68
|
| Rate for Payer: PacificSource Commercial |
$239.40
|
| Rate for Payer: PHCS PPO |
$260.68
|
| Rate for Payer: Three Rivers PPO |
$199.50
|
| Rate for Payer: TriWest Veterans Administration |
$154.28
|
| Rate for Payer: United Healthcare Commercial |
$231.42
|
| Rate for Payer: United Healthcare Medicare |
$154.28
|
| Rate for Payer: WINHealth Partners Commercial |
$260.68
|
| Rate for Payer: Wise Provider Network Commercial |
$252.70
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.36
|
| Rate for Payer: Altius Commercial |
$255.36
|
| Rate for Payer: Beech Street Commercial |
$260.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.39
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.02
|
| Rate for Payer: Cigna of WY Commercial |
$260.68
|
| Rate for Payer: Entrust Commercial |
$252.70
|
| Rate for Payer: First Choice Health Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.56
|
| Rate for Payer: HealthUtah PPO |
$266.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.02
|
| Rate for Payer: Multiplan Medicare/VA |
$166.78
|
| Rate for Payer: One Health Plan of WY PPO |
$260.68
|
| Rate for Payer: PacificSource Commercial |
$239.40
|
| Rate for Payer: PHCS PPO |
$260.68
|
| Rate for Payer: Three Rivers PPO |
$199.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$231.42
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
| Rate for Payer: WINHealth Partners Commercial |
$252.70
|
| Rate for Payer: Wise Provider Network Commercial |
$252.70
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA (SCL-70) ANTIBODY
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA (SCL-70) ANTIBODY
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
