|
HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES IGM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
3028614803
|
|
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 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 97750
|
| Hospital Charge Code |
5109775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.88
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.48
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$17.56
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$18.48
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: United Healthcare Medicare |
$18.48
|
| Rate for Payer: WINHealth Partners Commercial |
$26.60
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
HC PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 97750
|
| Hospital Charge Code |
5109775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$18.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.88
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.24
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$15.43
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$16.24
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: United Healthcare Medicare |
$16.24
|
| Rate for Payer: WINHealth Partners Commercial |
$27.44
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
HC PHYSICAL THERAPY GENERAL
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
4200000003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.74
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$56.75
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.74
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$59.74
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC PHYSICAL THERAPY GENERAL
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
4200000003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.98
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$64.58
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.98
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$67.98
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC PHYS SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
3108830403
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC PHYS SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
3108830403
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC PINWORM EXAM - PINWORM PREP
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
3068717201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC PINWORM EXAM - PINWORM PREP
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
3068717201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC PLACE CATH IN VEIN,SELECT
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
3613601101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACE CATH IN VEIN,SELECT
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
3613601101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACEMENT NG/OG TUBE BY PHYSICIAN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
7614375201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACEMENT NG/OG TUBE BY PHYSICIAN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
7614375201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACEMENT NG/OG TUBE BY PHYSICIAN
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
3204375201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$994.56 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,768.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,191.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,732.80
|
| Rate for Payer: Altius Commercial |
$1,732.80
|
| Rate for Payer: Beech Street Commercial |
$1,768.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,481.90
|
| Rate for Payer: Cash Price |
$1,263.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,750.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,768.90
|
| Rate for Payer: Entrust Commercial |
$1,714.75
|
| Rate for Payer: First Choice Health Commercial |
$1,714.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,714.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,046.90
|
| Rate for Payer: HealthUtah PPO |
$1,805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,750.85
|
| Rate for Payer: Multiplan Medicare/VA |
$994.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,768.90
|
| Rate for Payer: PacificSource Commercial |
$1,624.50
|
| Rate for Payer: PHCS PPO |
$1,768.90
|
| Rate for Payer: Three Rivers PPO |
$1,353.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,046.90
|
| Rate for Payer: United Healthcare Commercial |
$1,570.35
|
| Rate for Payer: United Healthcare Medicare |
$1,046.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,768.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,714.75
|
|
|
HC PLACEMENT NG/OG TUBE BY PHYSICIAN
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
3204375201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,131.74 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,768.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,732.80
|
| Rate for Payer: Altius Commercial |
$1,732.80
|
| Rate for Payer: Beech Street Commercial |
$1,768.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,481.90
|
| Rate for Payer: Cash Price |
$1,263.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,750.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,768.90
|
| Rate for Payer: Entrust Commercial |
$1,714.75
|
| Rate for Payer: First Choice Health Commercial |
$1,714.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,714.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,191.30
|
| Rate for Payer: HealthUtah PPO |
$1,805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,750.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1,131.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,768.90
|
| Rate for Payer: PacificSource Commercial |
$1,624.50
|
| Rate for Payer: PHCS PPO |
$1,768.90
|
| Rate for Payer: Three Rivers PPO |
$1,353.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,191.30
|
| Rate for Payer: United Healthcare Commercial |
$1,570.35
|
| Rate for Payer: United Healthcare Medicare |
$1,191.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,714.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,714.75
|
|
|
HC PLACE NEEDLE IN VEIN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
3613600001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACE NEEDLE IN VEIN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 36000
|
| Hospital Charge Code |
3613600001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC PLACENTAL ALPHA MICROGLOBULIN IG C/V
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 84112
|
| Hospital Charge Code |
3018411201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
HC PLACENTAL ALPHA MICROGLOBULIN IG C/V
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 84112
|
| Hospital Charge Code |
3018411201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
HC PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGA
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602204
|
|
Hospital Revenue Code
|
302
|
| 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 PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGA
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602204
|
|
Hospital Revenue Code
|
302
|
| 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 PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602203
|
|
Hospital Revenue Code
|
302
|
| 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 PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602203
|
|
Hospital Revenue Code
|
302
|
| 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 PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602205
|
|
Hospital Revenue Code
|
302
|
| 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 PLATELET ANTIBODIES - ANTI PLATELET ANTIBODY IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
3028602205
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
