|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
3028643001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86430
|
| Hospital Charge Code |
3028643001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
5103040001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$534.83 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$818.88
|
| Rate for Payer: Altius Commercial |
$818.88
|
| Rate for Payer: Beech Street Commercial |
$835.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$700.31
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: Entrust Commercial |
$810.35
|
| Rate for Payer: First Choice Health Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$562.98
|
| Rate for Payer: HealthUtah PPO |
$853.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$534.83
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$835.94
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$562.98
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$562.98
|
| Rate for Payer: WINHealth Partners Commercial |
$810.35
|
| Rate for Payer: Wise Provider Network Commercial |
$810.35
|
|
|
HC RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
5103040001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Aetna of WY Medicare |
$562.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$818.88
|
| Rate for Payer: Altius Commercial |
$818.88
|
| Rate for Payer: Beech Street Commercial |
$835.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$700.31
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: Entrust Commercial |
$810.35
|
| Rate for Payer: First Choice Health Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$494.74
|
| Rate for Payer: HealthUtah PPO |
$853.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$470.00
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$835.94
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$494.74
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$494.74
|
| Rate for Payer: WINHealth Partners Commercial |
$835.94
|
| Rate for Payer: Wise Provider Network Commercial |
$810.35
|
|
|
HC RH PHENOTYPING COMPLETE
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
3008690601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$158.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.20
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$132.24
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.20
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$139.20
|
| Rate for Payer: WINHealth Partners Commercial |
$235.20
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC RH PHENOTYPING COMPLETE
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
3008690601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.40
|
| Rate for Payer: Altius Commercial |
$230.40
|
| Rate for Payer: Beech Street Commercial |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.04
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: Entrust Commercial |
$228.00
|
| Rate for Payer: First Choice Health Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.40
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$150.48
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$235.20
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$158.40
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
| Rate for Payer: Wise Provider Network Commercial |
$228.00
|
|
|
HC RIA NONANTIBODY
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351914
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.42 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.52
|
| Rate for Payer: Aetna of WY Medicare |
$147.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.04
|
| Rate for Payer: Altius Commercial |
$215.04
|
| Rate for Payer: Beech Street Commercial |
$219.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$183.90
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.28
|
| Rate for Payer: Cigna of WY Commercial |
$219.52
|
| Rate for Payer: Entrust Commercial |
$212.80
|
| Rate for Payer: First Choice Health Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.92
|
| Rate for Payer: HealthUtah PPO |
$224.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.28
|
| Rate for Payer: Multiplan Medicare/VA |
$123.42
|
| Rate for Payer: One Health Plan of WY PPO |
$219.52
|
| Rate for Payer: PacificSource Commercial |
$201.60
|
| Rate for Payer: PHCS PPO |
$219.52
|
| Rate for Payer: Three Rivers PPO |
$168.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$194.88
|
| Rate for Payer: United Healthcare Medicare |
$129.92
|
| Rate for Payer: WINHealth Partners Commercial |
$219.52
|
| Rate for Payer: Wise Provider Network Commercial |
$212.80
|
|
|
HC RIA NONANTIBODY
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351914
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$219.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.04
|
| Rate for Payer: Altius Commercial |
$215.04
|
| Rate for Payer: Beech Street Commercial |
$219.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$183.90
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$217.28
|
| Rate for Payer: Cigna of WY Commercial |
$219.52
|
| Rate for Payer: Entrust Commercial |
$212.80
|
| Rate for Payer: First Choice Health Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$212.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.84
|
| Rate for Payer: HealthUtah PPO |
$224.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$217.28
|
| Rate for Payer: Multiplan Medicare/VA |
$140.45
|
| Rate for Payer: One Health Plan of WY PPO |
$219.52
|
| Rate for Payer: PacificSource Commercial |
$201.60
|
| Rate for Payer: PHCS PPO |
$219.52
|
| Rate for Payer: Three Rivers PPO |
$168.00
|
| Rate for Payer: TriWest Veterans Administration |
$147.84
|
| Rate for Payer: United Healthcare Commercial |
$194.88
|
| Rate for Payer: United Healthcare Medicare |
$147.84
|
| Rate for Payer: WINHealth Partners Commercial |
$212.80
|
| Rate for Payer: Wise Provider Network Commercial |
$212.80
|
|
|
HC RIA NONANTIBODY - ACETYLCHOLINE RECEP BIND
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - ACETYLCHOLINE RECEP BIND
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - ACETYLCHOLINE RECEPTOR
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351911
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - ACETYLCHOLINE RECEPTOR
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351911
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.85 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$192.85
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$203.00
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
HC RIA NONANTIBODY - GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$219.45 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$219.45
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$231.00
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
HC RIA NONANTIBODY - MUSK ANTIBODY
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - MUSK ANTIBODY
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - PANCREATIC POLYPEPTIDE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - PANCREATIC POLYPEPTIDE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - PROCOLLAGEN
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - PROCOLLAGEN
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351906
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - T4 ANTIBODY
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - T4 ANTIBODY
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - TSK RECEPTOR
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC RIA NONANTIBODY - TSK RECEPTOR
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
3018351905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
