HC SP COGNITIVE FUNCT THER INTERV, INITIAL 15 MIN
|
Facility
|
IP
|
$110.00
|
|
Service Code
|
HCPCS 97129
|
Hospital Charge Code |
4409712901
|
Hospital Revenue Code
|
440
|
Min. Negotiated Rate |
$68.97 |
Max. Negotiated Rate |
$110.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
Rate for Payer: Altius Commercial |
$105.60
|
Rate for Payer: Beech Street Commercial |
$107.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
Rate for Payer: Cash Price |
$77.00
|
Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
Rate for Payer: Cigna of WY Commercial |
$107.80
|
Rate for Payer: Entrust Commercial |
$104.50
|
Rate for Payer: First Choice Health Commercial |
$104.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
Rate for Payer: HealthUtah PPO |
$110.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
Rate for Payer: Multiplan Medicare/VA |
$68.97
|
Rate for Payer: One Health Plan of WY PPO |
$107.80
|
Rate for Payer: PacificSource Commercial |
$99.00
|
Rate for Payer: PHCS PPO |
$107.80
|
Rate for Payer: Three Rivers PPO |
$82.50
|
Rate for Payer: TriWest Veterans Administration |
$72.60
|
Rate for Payer: United Healthcare Commercial |
$95.70
|
Rate for Payer: United Healthcare Medicare |
$72.60
|
Rate for Payer: WINHealth Partners Commercial |
$104.50
|
Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
HC SP COGNITIVE FUNCT THER INTERV, INITIAL 15 MIN
|
Facility
|
OP
|
$110.00
|
|
Service Code
|
HCPCS 97129
|
Hospital Charge Code |
4409712901
|
Hospital Revenue Code
|
440
|
Min. Negotiated Rate |
$60.61 |
Max. Negotiated Rate |
$110.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
Rate for Payer: Aetna of WY Medicare |
$72.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
Rate for Payer: Altius Commercial |
$105.60
|
Rate for Payer: Beech Street Commercial |
$107.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
Rate for Payer: Cash Price |
$77.00
|
Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
Rate for Payer: Cigna of WY Commercial |
$107.80
|
Rate for Payer: Entrust Commercial |
$104.50
|
Rate for Payer: First Choice Health Commercial |
$104.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
Rate for Payer: HealthUtah PPO |
$110.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
Rate for Payer: Multiplan Medicare/VA |
$60.61
|
Rate for Payer: One Health Plan of WY PPO |
$107.80
|
Rate for Payer: PacificSource Commercial |
$99.00
|
Rate for Payer: PHCS PPO |
$107.80
|
Rate for Payer: Three Rivers PPO |
$82.50
|
Rate for Payer: TriWest Veterans Administration |
$63.80
|
Rate for Payer: United Healthcare Commercial |
$95.70
|
Rate for Payer: United Healthcare Medicare |
$63.80
|
Rate for Payer: WINHealth Partners Commercial |
$107.80
|
Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
HC SPECIAL ANESTHESIA SERVICE
|
Facility
|
OP
|
$243.00
|
|
Service Code
|
HCPCS 99100
|
Hospital Charge Code |
9649910001
|
Hospital Revenue Code
|
964
|
Min. Negotiated Rate |
$133.89 |
Max. Negotiated Rate |
$243.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
Rate for Payer: Aetna of WY Medicare |
$160.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$233.28
|
Rate for Payer: Altius Commercial |
$233.28
|
Rate for Payer: Beech Street Commercial |
$238.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.50
|
Rate for Payer: Cash Price |
$170.10
|
Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
Rate for Payer: Cigna of WY Commercial |
$238.14
|
Rate for Payer: Entrust Commercial |
$230.85
|
Rate for Payer: First Choice Health Commercial |
$230.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.94
|
Rate for Payer: HealthUtah PPO |
$243.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
Rate for Payer: Multiplan Medicare/VA |
$133.89
|
Rate for Payer: One Health Plan of WY PPO |
$238.14
|
Rate for Payer: PacificSource Commercial |
$218.70
|
Rate for Payer: PHCS PPO |
$238.14
|
Rate for Payer: Three Rivers PPO |
$182.25
|
Rate for Payer: TriWest Veterans Administration |
$140.94
|
Rate for Payer: United Healthcare Commercial |
$211.41
|
Rate for Payer: United Healthcare Medicare |
$140.94
|
Rate for Payer: WINHealth Partners Commercial |
$238.14
|
Rate for Payer: Wise Provider Network Commercial |
$230.85
|
|
HC SPECIAL ANESTHESIA SERVICE
|
Facility
|
IP
|
$243.00
|
|
Service Code
|
HCPCS 99100
|
Hospital Charge Code |
9649910001
|
Hospital Revenue Code
|
964
|
Min. Negotiated Rate |
$152.36 |
Max. Negotiated Rate |
$243.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
Rate for Payer: Altius Auto/Workers Compensation |
$233.28
|
Rate for Payer: Altius Commercial |
$233.28
|
Rate for Payer: Beech Street Commercial |
$238.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.50
|
Rate for Payer: Cash Price |
$170.10
|
Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
Rate for Payer: Cigna of WY Commercial |
$238.14
|
Rate for Payer: Entrust Commercial |
$230.85
|
Rate for Payer: First Choice Health Commercial |
$230.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.38
|
Rate for Payer: HealthUtah PPO |
$243.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
Rate for Payer: Multiplan Medicare/VA |
$152.36
|
Rate for Payer: One Health Plan of WY PPO |
$238.14
|
Rate for Payer: PacificSource Commercial |
$218.70
|
Rate for Payer: PHCS PPO |
$238.14
|
Rate for Payer: Three Rivers PPO |
$182.25
|
Rate for Payer: TriWest Veterans Administration |
$160.38
|
Rate for Payer: United Healthcare Commercial |
$211.41
|
Rate for Payer: United Healthcare Medicare |
$160.38
|
Rate for Payer: WINHealth Partners Commercial |
$230.85
|
Rate for Payer: Wise Provider Network Commercial |
$230.85
|
|
HC SPECIAL STAINS,GROUP II - LAB SPECIAL STAINS,GROUP II
|
Facility
|
IP
|
$210.00
|
|
Service Code
|
HCPCS 88313
|
Hospital Charge Code |
3128831301
|
Hospital Revenue Code
|
312
|
Min. Negotiated Rate |
$131.67 |
Max. Negotiated Rate |
$210.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
Rate for Payer: Altius Commercial |
$201.60
|
Rate for Payer: Beech Street Commercial |
$205.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
Rate for Payer: Cash Price |
$147.00
|
Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
Rate for Payer: Cigna of WY Commercial |
$205.80
|
Rate for Payer: Entrust Commercial |
$199.50
|
Rate for Payer: First Choice Health Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
Rate for Payer: HealthUtah PPO |
$210.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
Rate for Payer: Multiplan Medicare/VA |
$131.67
|
Rate for Payer: One Health Plan of WY PPO |
$205.80
|
Rate for Payer: PacificSource Commercial |
$189.00
|
Rate for Payer: PHCS PPO |
$205.80
|
Rate for Payer: Three Rivers PPO |
$157.50
|
Rate for Payer: TriWest Veterans Administration |
$138.60
|
Rate for Payer: United Healthcare Commercial |
$182.70
|
Rate for Payer: United Healthcare Medicare |
$138.60
|
Rate for Payer: WINHealth Partners Commercial |
$199.50
|
Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
HC SPECIAL STAINS,GROUP II - LAB SPECIAL STAINS,GROUP II
|
Facility
|
OP
|
$210.00
|
|
Service Code
|
HCPCS 88313
|
Hospital Charge Code |
3128831301
|
Hospital Revenue Code
|
312
|
Min. Negotiated Rate |
$115.71 |
Max. Negotiated Rate |
$210.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
Rate for Payer: Aetna of WY Medicare |
$138.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
Rate for Payer: Altius Commercial |
$201.60
|
Rate for Payer: Beech Street Commercial |
$205.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
Rate for Payer: Cash Price |
$147.00
|
Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
Rate for Payer: Cigna of WY Commercial |
$205.80
|
Rate for Payer: Entrust Commercial |
$199.50
|
Rate for Payer: First Choice Health Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
Rate for Payer: HealthUtah PPO |
$210.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
Rate for Payer: Multiplan Medicare/VA |
$115.71
|
Rate for Payer: One Health Plan of WY PPO |
$205.80
|
Rate for Payer: PacificSource Commercial |
$189.00
|
Rate for Payer: PHCS PPO |
$205.80
|
Rate for Payer: Three Rivers PPO |
$157.50
|
Rate for Payer: TriWest Veterans Administration |
$121.80
|
Rate for Payer: United Healthcare Commercial |
$182.70
|
Rate for Payer: United Healthcare Medicare |
$121.80
|
Rate for Payer: WINHealth Partners Commercial |
$205.80
|
Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I
|
Facility
|
IP
|
$230.00
|
|
Service Code
|
HCPCS 88312
|
Hospital Charge Code |
3108831201
|
Hospital Revenue Code
|
310
|
Min. Negotiated Rate |
$144.21 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$144.21
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$151.80
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$151.80
|
Rate for Payer: WINHealth Partners Commercial |
$218.50
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I
|
Facility
|
OP
|
$230.00
|
|
Service Code
|
HCPCS 88312
|
Hospital Charge Code |
3128831201
|
Hospital Revenue Code
|
312
|
Min. Negotiated Rate |
$126.73 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Aetna of WY Medicare |
$151.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$126.73
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$133.40
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$133.40
|
Rate for Payer: WINHealth Partners Commercial |
$225.40
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I
|
Facility
|
IP
|
$230.00
|
|
Service Code
|
HCPCS 88312
|
Hospital Charge Code |
3128831201
|
Hospital Revenue Code
|
312
|
Min. Negotiated Rate |
$144.21 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$144.21
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$151.80
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$151.80
|
Rate for Payer: WINHealth Partners Commercial |
$218.50
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I
|
Facility
|
OP
|
$230.00
|
|
Service Code
|
HCPCS 88312
|
Hospital Charge Code |
3108831201
|
Hospital Revenue Code
|
310
|
Min. Negotiated Rate |
$126.73 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Aetna of WY Medicare |
$151.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$126.73
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$133.40
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$133.40
|
Rate for Payer: WINHealth Partners Commercial |
$225.40
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIALTY CARE TRANSPORT
|
Facility
|
IP
|
$11,680.00
|
|
Service Code
|
HCPCS A0434
|
Hospital Charge Code |
540A043401
|
Hospital Revenue Code
|
540
|
Min. Negotiated Rate |
$7,323.36 |
Max. Negotiated Rate |
$11,680.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,446.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$11,212.80
|
Rate for Payer: Altius Commercial |
$11,212.80
|
Rate for Payer: Beech Street Commercial |
$11,446.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,589.28
|
Rate for Payer: Cash Price |
$8,176.00
|
Rate for Payer: ChoiceCare Network Commercial |
$11,329.60
|
Rate for Payer: Cigna of WY Commercial |
$11,446.40
|
Rate for Payer: Entrust Commercial |
$11,096.00
|
Rate for Payer: First Choice Health Commercial |
$11,096.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,096.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,708.80
|
Rate for Payer: HealthUtah PPO |
$11,680.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,329.60
|
Rate for Payer: Multiplan Medicare/VA |
$7,323.36
|
Rate for Payer: One Health Plan of WY PPO |
$11,446.40
|
Rate for Payer: PacificSource Commercial |
$10,512.00
|
Rate for Payer: PHCS PPO |
$11,446.40
|
Rate for Payer: Three Rivers PPO |
$8,760.00
|
Rate for Payer: TriWest Veterans Administration |
$7,708.80
|
Rate for Payer: United Healthcare Commercial |
$10,161.60
|
Rate for Payer: United Healthcare Medicare |
$7,708.80
|
Rate for Payer: WINHealth Partners Commercial |
$11,096.00
|
Rate for Payer: Wise Provider Network Commercial |
$11,096.00
|
|
HC SPECIALTY CARE TRANSPORT
|
Facility
|
OP
|
$11,680.00
|
|
Service Code
|
HCPCS A0434
|
Hospital Charge Code |
540A043401
|
Hospital Revenue Code
|
540
|
Min. Negotiated Rate |
$6,435.68 |
Max. Negotiated Rate |
$11,680.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,446.40
|
Rate for Payer: Aetna of WY Medicare |
$7,708.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$11,212.80
|
Rate for Payer: Altius Commercial |
$11,212.80
|
Rate for Payer: Beech Street Commercial |
$11,446.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,589.28
|
Rate for Payer: Cash Price |
$8,176.00
|
Rate for Payer: ChoiceCare Network Commercial |
$11,329.60
|
Rate for Payer: Cigna of WY Commercial |
$11,446.40
|
Rate for Payer: Entrust Commercial |
$11,096.00
|
Rate for Payer: First Choice Health Commercial |
$11,096.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,096.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,774.40
|
Rate for Payer: HealthUtah PPO |
$11,680.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,329.60
|
Rate for Payer: Multiplan Medicare/VA |
$6,435.68
|
Rate for Payer: One Health Plan of WY PPO |
$11,446.40
|
Rate for Payer: PacificSource Commercial |
$10,512.00
|
Rate for Payer: PHCS PPO |
$11,446.40
|
Rate for Payer: Three Rivers PPO |
$8,760.00
|
Rate for Payer: TriWest Veterans Administration |
$6,774.40
|
Rate for Payer: United Healthcare Commercial |
$10,161.60
|
Rate for Payer: United Healthcare Medicare |
$6,774.40
|
Rate for Payer: WINHealth Partners Commercial |
$11,446.40
|
Rate for Payer: Wise Provider Network Commercial |
$11,096.00
|
|
HC SPECIMEN COLLECT COVID 19
|
Facility
|
OP
|
$230.00
|
|
Service Code
|
HCPCS G2023
|
Hospital Charge Code |
300G202301
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$126.73 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Aetna of WY Medicare |
$151.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$126.73
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$133.40
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$133.40
|
Rate for Payer: WINHealth Partners Commercial |
$225.40
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIMEN COLLECT COVID 19
|
Facility
|
IP
|
$230.00
|
|
Service Code
|
HCPCS G2023
|
Hospital Charge Code |
300G202301
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$144.21 |
Max. Negotiated Rate |
$230.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
Rate for Payer: Altius Commercial |
$220.80
|
Rate for Payer: Beech Street Commercial |
$225.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
Rate for Payer: Cash Price |
$161.00
|
Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
Rate for Payer: Cigna of WY Commercial |
$225.40
|
Rate for Payer: Entrust Commercial |
$218.50
|
Rate for Payer: First Choice Health Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
Rate for Payer: HealthUtah PPO |
$230.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
Rate for Payer: Multiplan Medicare/VA |
$144.21
|
Rate for Payer: One Health Plan of WY PPO |
$225.40
|
Rate for Payer: PacificSource Commercial |
$207.00
|
Rate for Payer: PHCS PPO |
$225.40
|
Rate for Payer: Three Rivers PPO |
$172.50
|
Rate for Payer: TriWest Veterans Administration |
$151.80
|
Rate for Payer: United Healthcare Commercial |
$200.10
|
Rate for Payer: United Healthcare Medicare |
$151.80
|
Rate for Payer: WINHealth Partners Commercial |
$218.50
|
Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
HC SPECIMEN CONCENTRATION - BROTH TECH
|
Facility
|
IP
|
$95.00
|
|
Service Code
|
HCPCS 87015
|
Hospital Charge Code |
3068701502
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$59.56 |
Max. Negotiated Rate |
$95.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
Rate for Payer: Altius Commercial |
$91.20
|
Rate for Payer: Beech Street Commercial |
$93.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
Rate for Payer: Cash Price |
$66.50
|
Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
Rate for Payer: Cigna of WY Commercial |
$93.10
|
Rate for Payer: Entrust Commercial |
$90.25
|
Rate for Payer: First Choice Health Commercial |
$90.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
Rate for Payer: HealthUtah PPO |
$95.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
Rate for Payer: Multiplan Medicare/VA |
$59.56
|
Rate for Payer: One Health Plan of WY PPO |
$93.10
|
Rate for Payer: PacificSource Commercial |
$85.50
|
Rate for Payer: PHCS PPO |
$93.10
|
Rate for Payer: Three Rivers PPO |
$71.25
|
Rate for Payer: TriWest Veterans Administration |
$62.70
|
Rate for Payer: United Healthcare Commercial |
$82.65
|
Rate for Payer: United Healthcare Medicare |
$62.70
|
Rate for Payer: WINHealth Partners Commercial |
$90.25
|
Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
HC SPECIMEN CONCENTRATION - BROTH TECH
|
Facility
|
OP
|
$95.00
|
|
Service Code
|
HCPCS 87015
|
Hospital Charge Code |
3068701502
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$52.34 |
Max. Negotiated Rate |
$95.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
Rate for Payer: Aetna of WY Medicare |
$62.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
Rate for Payer: Altius Commercial |
$91.20
|
Rate for Payer: Beech Street Commercial |
$93.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
Rate for Payer: Cash Price |
$66.50
|
Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
Rate for Payer: Cigna of WY Commercial |
$93.10
|
Rate for Payer: Entrust Commercial |
$90.25
|
Rate for Payer: First Choice Health Commercial |
$90.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
Rate for Payer: HealthUtah PPO |
$95.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
Rate for Payer: Multiplan Medicare/VA |
$52.34
|
Rate for Payer: One Health Plan of WY PPO |
$93.10
|
Rate for Payer: PacificSource Commercial |
$85.50
|
Rate for Payer: PHCS PPO |
$93.10
|
Rate for Payer: Three Rivers PPO |
$71.25
|
Rate for Payer: TriWest Veterans Administration |
$55.10
|
Rate for Payer: United Healthcare Commercial |
$82.65
|
Rate for Payer: United Healthcare Medicare |
$55.10
|
Rate for Payer: WINHealth Partners Commercial |
$93.10
|
Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
HC SPECTROPHOTOMETRY ANALYTE NOS - BODY FLUID CHOLESTEROL
|
Facility
|
IP
|
$115.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431103
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$72.10 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$72.10
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$75.90
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$75.90
|
Rate for Payer: WINHealth Partners Commercial |
$109.25
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC SPECTROPHOTOMETRY ANALYTE NOS - BODY FLUID CHOLESTEROL
|
Facility
|
OP
|
$115.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431103
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$63.36 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Aetna of WY Medicare |
$75.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$63.36
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$66.70
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$66.70
|
Rate for Payer: WINHealth Partners Commercial |
$112.70
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC SPECTROPHOTOMETRY ANALYTE NOS - HEMOGLOBIN SF
|
Facility
|
OP
|
$190.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431104
|
Hospital Revenue Code
|
301
|
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 SPECTROPHOTOMETRY ANALYTE NOS - HEMOGLOBIN SF
|
Facility
|
IP
|
$190.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431104
|
Hospital Revenue Code
|
301
|
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 SPECTROPHOTOMETRY - PORPHYRIN TOTAL
|
Facility
|
IP
|
$115.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431101
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$72.10 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$72.10
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$75.90
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$75.90
|
Rate for Payer: WINHealth Partners Commercial |
$109.25
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC SPECTROPHOTOMETRY - PORPHYRIN TOTAL
|
Facility
|
OP
|
$115.00
|
|
Service Code
|
HCPCS 84311
|
Hospital Charge Code |
3018431101
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$63.36 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
Rate for Payer: Aetna of WY Medicare |
$75.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
Rate for Payer: Altius Commercial |
$110.40
|
Rate for Payer: Beech Street Commercial |
$112.70
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
Rate for Payer: Cash Price |
$80.50
|
Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
Rate for Payer: Cigna of WY Commercial |
$112.70
|
Rate for Payer: Entrust Commercial |
$109.25
|
Rate for Payer: First Choice Health Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
Rate for Payer: HealthUtah PPO |
$115.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
Rate for Payer: Multiplan Medicare/VA |
$63.36
|
Rate for Payer: One Health Plan of WY PPO |
$112.70
|
Rate for Payer: PacificSource Commercial |
$103.50
|
Rate for Payer: PHCS PPO |
$112.70
|
Rate for Payer: Three Rivers PPO |
$86.25
|
Rate for Payer: TriWest Veterans Administration |
$66.70
|
Rate for Payer: United Healthcare Commercial |
$100.05
|
Rate for Payer: United Healthcare Medicare |
$66.70
|
Rate for Payer: WINHealth Partners Commercial |
$112.70
|
Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
HC SPERM ANTIBODY IGA
|
Facility
|
IP
|
$70.00
|
|
Service Code
|
HCPCS 89325
|
Hospital Charge Code |
3008932501
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$43.89 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
Rate for Payer: Altius Commercial |
$67.20
|
Rate for Payer: Beech Street Commercial |
$68.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
Rate for Payer: Cash Price |
$49.00
|
Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
Rate for Payer: Cigna of WY Commercial |
$68.60
|
Rate for Payer: Entrust Commercial |
$66.50
|
Rate for Payer: First Choice Health Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
Rate for Payer: HealthUtah PPO |
$70.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
Rate for Payer: Multiplan Medicare/VA |
$43.89
|
Rate for Payer: One Health Plan of WY PPO |
$68.60
|
Rate for Payer: PacificSource Commercial |
$63.00
|
Rate for Payer: PHCS PPO |
$68.60
|
Rate for Payer: Three Rivers PPO |
$52.50
|
Rate for Payer: TriWest Veterans Administration |
$46.20
|
Rate for Payer: United Healthcare Commercial |
$60.90
|
Rate for Payer: United Healthcare Medicare |
$46.20
|
Rate for Payer: WINHealth Partners Commercial |
$66.50
|
Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
HC SPERM ANTIBODY IGA
|
Facility
|
OP
|
$70.00
|
|
Service Code
|
HCPCS 89325
|
Hospital Charge Code |
3008932501
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$38.57 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
Rate for Payer: Aetna of WY Medicare |
$46.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
Rate for Payer: Altius Commercial |
$67.20
|
Rate for Payer: Beech Street Commercial |
$68.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
Rate for Payer: Cash Price |
$49.00
|
Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
Rate for Payer: Cigna of WY Commercial |
$68.60
|
Rate for Payer: Entrust Commercial |
$66.50
|
Rate for Payer: First Choice Health Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
Rate for Payer: HealthUtah PPO |
$70.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
Rate for Payer: Multiplan Medicare/VA |
$38.57
|
Rate for Payer: One Health Plan of WY PPO |
$68.60
|
Rate for Payer: PacificSource Commercial |
$63.00
|
Rate for Payer: PHCS PPO |
$68.60
|
Rate for Payer: Three Rivers PPO |
$52.50
|
Rate for Payer: TriWest Veterans Administration |
$40.60
|
Rate for Payer: United Healthcare Commercial |
$60.90
|
Rate for Payer: United Healthcare Medicare |
$40.60
|
Rate for Payer: WINHealth Partners Commercial |
$68.60
|
Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
HC SPERM ANTIBODY IGG
|
Facility
|
OP
|
$70.00
|
|
Service Code
|
HCPCS 89325
|
Hospital Charge Code |
3008932502
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$38.57 |
Max. Negotiated Rate |
$70.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
Rate for Payer: Aetna of WY Medicare |
$46.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
Rate for Payer: Altius Commercial |
$67.20
|
Rate for Payer: Beech Street Commercial |
$68.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
Rate for Payer: Cash Price |
$49.00
|
Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
Rate for Payer: Cigna of WY Commercial |
$68.60
|
Rate for Payer: Entrust Commercial |
$66.50
|
Rate for Payer: First Choice Health Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
Rate for Payer: HealthUtah PPO |
$70.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
Rate for Payer: Multiplan Medicare/VA |
$38.57
|
Rate for Payer: One Health Plan of WY PPO |
$68.60
|
Rate for Payer: PacificSource Commercial |
$63.00
|
Rate for Payer: PHCS PPO |
$68.60
|
Rate for Payer: Three Rivers PPO |
$52.50
|
Rate for Payer: TriWest Veterans Administration |
$40.60
|
Rate for Payer: United Healthcare Commercial |
$60.90
|
Rate for Payer: United Healthcare Medicare |
$40.60
|
Rate for Payer: WINHealth Partners Commercial |
$68.60
|
Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|