|
HC OT WORK HARDENING/CONDN,0-2 HR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 97545
|
| Hospital Charge Code |
4309754501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC OT WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
4309760201
|
|
Hospital Revenue Code
|
430
|
| 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 OT WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
4309760201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| 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 |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| 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 |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
9439379801
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Aetna of WY Medicare |
$297.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$247.95
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$261.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$261.00
|
| Rate for Payer: WINHealth Partners Commercial |
$441.00
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
9439379801
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$282.15 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$432.00
|
| Rate for Payer: Altius Commercial |
$432.00
|
| Rate for Payer: Beech Street Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$369.45
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$436.50
|
| Rate for Payer: Cigna of WY Commercial |
$441.00
|
| Rate for Payer: Entrust Commercial |
$427.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.00
|
| Rate for Payer: HealthUtah PPO |
$450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$436.50
|
| Rate for Payer: Multiplan Medicare/VA |
$282.15
|
| Rate for Payer: One Health Plan of WY PPO |
$441.00
|
| Rate for Payer: PacificSource Commercial |
$405.00
|
| Rate for Payer: PHCS PPO |
$441.00
|
| Rate for Payer: Three Rivers PPO |
$337.50
|
| Rate for Payer: TriWest Veterans Administration |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$297.00
|
| Rate for Payer: WINHealth Partners Commercial |
$427.50
|
| Rate for Payer: Wise Provider Network Commercial |
$427.50
|
|
|
HC OVA 1
|
Facility
|
OP
|
$7,985.00
|
|
|
Service Code
|
HCPCS 81503
|
| Hospital Charge Code |
3108150301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4,399.74 |
| Max. Negotiated Rate |
$7,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,825.30
|
| Rate for Payer: Aetna of WY Medicare |
$5,270.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,665.60
|
| Rate for Payer: Altius Commercial |
$7,665.60
|
| Rate for Payer: Beech Street Commercial |
$7,825.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,555.68
|
| Rate for Payer: Cash Price |
$5,589.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,745.45
|
| Rate for Payer: Cigna of WY Commercial |
$7,825.30
|
| Rate for Payer: Entrust Commercial |
$7,585.75
|
| Rate for Payer: First Choice Health Commercial |
$7,585.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,585.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,631.30
|
| Rate for Payer: HealthUtah PPO |
$7,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,745.45
|
| Rate for Payer: Multiplan Medicare/VA |
$4,399.74
|
| Rate for Payer: One Health Plan of WY PPO |
$7,825.30
|
| Rate for Payer: PacificSource Commercial |
$7,186.50
|
| Rate for Payer: PHCS PPO |
$7,825.30
|
| Rate for Payer: Three Rivers PPO |
$5,988.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,631.30
|
| Rate for Payer: United Healthcare Commercial |
$6,946.95
|
| Rate for Payer: United Healthcare Medicare |
$4,631.30
|
| Rate for Payer: WINHealth Partners Commercial |
$7,825.30
|
| Rate for Payer: Wise Provider Network Commercial |
$7,585.75
|
|
|
HC OVA 1
|
Facility
|
IP
|
$7,985.00
|
|
|
Service Code
|
HCPCS 81503
|
| Hospital Charge Code |
3108150301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5,006.60 |
| Max. Negotiated Rate |
$7,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,825.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,665.60
|
| Rate for Payer: Altius Commercial |
$7,665.60
|
| Rate for Payer: Beech Street Commercial |
$7,825.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,555.68
|
| Rate for Payer: Cash Price |
$5,589.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,745.45
|
| Rate for Payer: Cigna of WY Commercial |
$7,825.30
|
| Rate for Payer: Entrust Commercial |
$7,585.75
|
| Rate for Payer: First Choice Health Commercial |
$7,585.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,585.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,270.10
|
| Rate for Payer: HealthUtah PPO |
$7,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,745.45
|
| Rate for Payer: Multiplan Medicare/VA |
$5,006.60
|
| Rate for Payer: One Health Plan of WY PPO |
$7,825.30
|
| Rate for Payer: PacificSource Commercial |
$7,186.50
|
| Rate for Payer: PHCS PPO |
$7,825.30
|
| Rate for Payer: Three Rivers PPO |
$5,988.75
|
| Rate for Payer: TriWest Veterans Administration |
$5,270.10
|
| Rate for Payer: United Healthcare Commercial |
$6,946.95
|
| Rate for Payer: United Healthcare Medicare |
$5,270.10
|
| Rate for Payer: WINHealth Partners Commercial |
$7,585.75
|
| Rate for Payer: Wise Provider Network Commercial |
$7,585.75
|
|
|
HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
3068717701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
3068717701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC PARAINFLUENZA POOL DFA
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
3008727901
|
|
Hospital Revenue Code
|
300
|
| 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 PARAINFLUENZA POOL DFA
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 87279
|
| Hospital Charge Code |
3008727901
|
|
Hospital Revenue Code
|
300
|
| 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 PARATHYROID PLANAR IMAGING - NM PARATHYROID
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
3417807001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,046.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,254.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,046.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,102.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,862.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC PARATHYROID PLANAR IMAGING - NM PARATHYROID
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
3417807001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,254.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,191.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,254.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,254.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - H INFLUENZAE B AG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - H INFLUENZAE B AG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS A/Y AG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS A/Y AG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS B E COLI K
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS B E COLI K
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS CW135 AG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - N MENINGITIDIS CW135 AG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - STREP GROUP B AG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC PARTICLE AGGLUTINATION SCREEN - STREP GROUP B AG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
3028640304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
