|
HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
3201928101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$738.34 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,313.20
|
| Rate for Payer: Aetna of WY Medicare |
$884.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,286.40
|
| Rate for Payer: Altius Commercial |
$1,286.40
|
| Rate for Payer: Beech Street Commercial |
$1,313.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,100.14
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,299.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,313.20
|
| Rate for Payer: Entrust Commercial |
$1,273.00
|
| Rate for Payer: First Choice Health Commercial |
$1,273.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$777.20
|
| Rate for Payer: HealthUtah PPO |
$1,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,299.80
|
| Rate for Payer: Multiplan Medicare/VA |
$738.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,313.20
|
| Rate for Payer: PacificSource Commercial |
$1,206.00
|
| Rate for Payer: PHCS PPO |
$1,313.20
|
| Rate for Payer: Three Rivers PPO |
$1,005.00
|
| Rate for Payer: TriWest Veterans Administration |
$777.20
|
| Rate for Payer: United Healthcare Commercial |
$1,165.80
|
| Rate for Payer: United Healthcare Medicare |
$777.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,313.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,273.00
|
|
|
HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 19281
|
| Hospital Charge Code |
3201928101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$840.18 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,313.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,286.40
|
| Rate for Payer: Altius Commercial |
$1,286.40
|
| Rate for Payer: Beech Street Commercial |
$1,313.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,100.14
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,299.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,313.20
|
| Rate for Payer: Entrust Commercial |
$1,273.00
|
| Rate for Payer: First Choice Health Commercial |
$1,273.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$884.40
|
| Rate for Payer: HealthUtah PPO |
$1,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,299.80
|
| Rate for Payer: Multiplan Medicare/VA |
$840.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,313.20
|
| Rate for Payer: PacificSource Commercial |
$1,206.00
|
| Rate for Payer: PHCS PPO |
$1,313.20
|
| Rate for Payer: Three Rivers PPO |
$1,005.00
|
| Rate for Payer: TriWest Veterans Administration |
$884.40
|
| Rate for Payer: United Healthcare Commercial |
$1,165.80
|
| Rate for Payer: United Healthcare Medicare |
$884.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,273.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,273.00
|
|
|
HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
6101928201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$608.86 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Aetna of WY Medicare |
$729.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$640.90
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$608.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$640.90
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$640.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,082.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 19282
|
| Hospital Charge Code |
6101928201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$692.84 |
| Max. Negotiated Rate |
$1,105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,082.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,060.80
|
| Rate for Payer: Altius Commercial |
$1,060.80
|
| Rate for Payer: Beech Street Commercial |
$1,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$907.20
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,071.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,082.90
|
| Rate for Payer: Entrust Commercial |
$1,049.75
|
| Rate for Payer: First Choice Health Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,049.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$729.30
|
| Rate for Payer: HealthUtah PPO |
$1,105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,071.85
|
| Rate for Payer: Multiplan Medicare/VA |
$692.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,082.90
|
| Rate for Payer: PacificSource Commercial |
$994.50
|
| Rate for Payer: PHCS PPO |
$1,082.90
|
| Rate for Payer: Three Rivers PPO |
$828.75
|
| Rate for Payer: TriWest Veterans Administration |
$729.30
|
| Rate for Payer: United Healthcare Commercial |
$961.35
|
| Rate for Payer: United Healthcare Medicare |
$729.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,049.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,049.75
|
|
|
HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
5103255601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$291.84
|
| Rate for Payer: Altius Commercial |
$291.84
|
| Rate for Payer: Beech Street Commercial |
$297.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$249.58
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: Entrust Commercial |
$288.80
|
| Rate for Payer: First Choice Health Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.64
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: Multiplan Medicare/VA |
$190.61
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PHCS PPO |
$297.92
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: TriWest Veterans Administration |
$200.64
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare |
$200.64
|
| Rate for Payer: WINHealth Partners Commercial |
$288.80
|
| Rate for Payer: Wise Provider Network Commercial |
$288.80
|
|
|
HC PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
5103255601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$167.50 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Aetna of WY Medicare |
$200.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$291.84
|
| Rate for Payer: Altius Commercial |
$291.84
|
| Rate for Payer: Beech Street Commercial |
$297.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$249.58
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: Entrust Commercial |
$288.80
|
| Rate for Payer: First Choice Health Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.32
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: Multiplan Medicare/VA |
$167.50
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PHCS PPO |
$297.92
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: TriWest Veterans Administration |
$176.32
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare |
$176.32
|
| Rate for Payer: WINHealth Partners Commercial |
$297.92
|
| Rate for Payer: Wise Provider Network Commercial |
$288.80
|
|
|
HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE
|
Facility
|
IP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
3611003501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,398.21 |
| Max. Negotiated Rate |
$2,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,185.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,140.80
|
| Rate for Payer: Altius Commercial |
$2,140.80
|
| Rate for Payer: Beech Street Commercial |
$2,185.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,830.83
|
| Rate for Payer: Cash Price |
$1,561.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,163.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,185.40
|
| Rate for Payer: Entrust Commercial |
$2,118.50
|
| Rate for Payer: First Choice Health Commercial |
$2,118.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,118.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.80
|
| Rate for Payer: HealthUtah PPO |
$2,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,163.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,185.40
|
| Rate for Payer: PacificSource Commercial |
$2,007.00
|
| Rate for Payer: PHCS PPO |
$2,185.40
|
| Rate for Payer: Three Rivers PPO |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.80
|
| Rate for Payer: United Healthcare Commercial |
$1,940.10
|
| Rate for Payer: United Healthcare Medicare |
$1,471.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,118.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,118.50
|
|
|
HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE
|
Facility
|
OP
|
$2,230.00
|
|
|
Service Code
|
HCPCS 10035
|
| Hospital Charge Code |
3611003501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,228.73 |
| Max. Negotiated Rate |
$2,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,185.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,471.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,140.80
|
| Rate for Payer: Altius Commercial |
$2,140.80
|
| Rate for Payer: Beech Street Commercial |
$2,185.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,830.83
|
| Rate for Payer: Cash Price |
$1,561.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,163.10
|
| Rate for Payer: Cigna of WY Commercial |
$2,185.40
|
| Rate for Payer: Entrust Commercial |
$2,118.50
|
| Rate for Payer: First Choice Health Commercial |
$2,118.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,118.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,293.40
|
| Rate for Payer: HealthUtah PPO |
$2,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,163.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,228.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2,185.40
|
| Rate for Payer: PacificSource Commercial |
$2,007.00
|
| Rate for Payer: PHCS PPO |
$2,185.40
|
| Rate for Payer: Three Rivers PPO |
$1,672.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,293.40
|
| Rate for Payer: United Healthcare Commercial |
$1,940.10
|
| Rate for Payer: United Healthcare Medicare |
$1,293.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,185.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,118.50
|
|
|
HC PHALANGE MYE
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 28150
|
| Hospital Charge Code |
7612815001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.52
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$421.34
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$443.52
|
| Rate for Payer: WINHealth Partners Commercial |
$638.40
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC PHALANGE MYE
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 28150
|
| Hospital Charge Code |
7612815001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$443.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.76
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$370.27
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$389.76
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$389.76
|
| Rate for Payer: WINHealth Partners Commercial |
$658.56
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC PHASE TWO TIME - INITIAL BASE CHARGE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
7100000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC PHASE TWO TIME - INITIAL BASE CHARGE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
7100000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC PH BODY FLUID NOS - PH BODY FLUID
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
3018398601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC PH BODY FLUID NOS - PH BODY FLUID
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
3018398601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC PH BODY FLUID NOS - PH STOOL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
3018398603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC PH BODY FLUID NOS - PH STOOL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
3018398603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
9409919501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
7619919501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.71 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$203.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$295.68
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.87
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.64
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$169.71
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$267.96
|
| Rate for Payer: United Healthcare Medicare |
$178.64
|
| Rate for Payer: WINHealth Partners Commercial |
$301.84
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
7619919501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.12 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$295.68
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.87
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.28
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$193.12
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$203.28
|
| Rate for Payer: United Healthcare Commercial |
$267.96
|
| Rate for Payer: United Healthcare Medicare |
$203.28
|
| Rate for Payer: WINHealth Partners Commercial |
$292.60
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
9409919501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGA
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGA
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGG
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGG
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
