|
HC THROMBOPLAS TIME PARTIAL (APTT) - PLASMA/WHOLE BLOOD
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
3058573001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3028680001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3028680001
|
|
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 THYROID HORMONE T3/T4 UPT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
3008447901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC THYROID HORMONE T3/T4 UPT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
3008447901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
3018447901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$29.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.10
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$24.80
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.10
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$26.10
|
| Rate for Payer: WINHealth Partners Commercial |
$44.10
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
3018447901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.20
|
| Rate for Payer: Altius Commercial |
$43.20
|
| Rate for Payer: Beech Street Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: Entrust Commercial |
$42.75
|
| Rate for Payer: First Choice Health Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.70
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$28.22
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$44.10
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$29.70
|
| Rate for Payer: WINHealth Partners Commercial |
$42.75
|
| Rate for Payer: Wise Provider Network Commercial |
$42.75
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID SCAN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
3417801301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$650.18 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,156.40
|
| Rate for Payer: Aetna of WY Medicare |
$778.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,132.80
|
| Rate for Payer: Altius Commercial |
$1,132.80
|
| Rate for Payer: Beech Street Commercial |
$1,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$968.78
|
| Rate for Payer: Cash Price |
$826.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,144.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,156.40
|
| Rate for Payer: Entrust Commercial |
$1,121.00
|
| Rate for Payer: First Choice Health Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.40
|
| Rate for Payer: HealthUtah PPO |
$1,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,144.60
|
| Rate for Payer: Multiplan Medicare/VA |
$650.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,156.40
|
| Rate for Payer: PacificSource Commercial |
$1,062.00
|
| Rate for Payer: PHCS PPO |
$1,156.40
|
| Rate for Payer: Three Rivers PPO |
$885.00
|
| Rate for Payer: TriWest Veterans Administration |
$684.40
|
| Rate for Payer: United Healthcare Commercial |
$1,026.60
|
| Rate for Payer: United Healthcare Medicare |
$684.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,121.00
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID SCAN
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
3417801301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,156.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,132.80
|
| Rate for Payer: Altius Commercial |
$1,132.80
|
| Rate for Payer: Beech Street Commercial |
$1,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$968.78
|
| Rate for Payer: Cash Price |
$826.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,144.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,156.40
|
| Rate for Payer: Entrust Commercial |
$1,121.00
|
| Rate for Payer: First Choice Health Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.80
|
| Rate for Payer: HealthUtah PPO |
$1,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,144.60
|
| Rate for Payer: Multiplan Medicare/VA |
$739.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,156.40
|
| Rate for Payer: PacificSource Commercial |
$1,062.00
|
| Rate for Payer: PHCS PPO |
$1,156.40
|
| Rate for Payer: Three Rivers PPO |
$885.00
|
| Rate for Payer: TriWest Veterans Administration |
$778.80
|
| Rate for Payer: United Healthcare Commercial |
$1,026.60
|
| Rate for Payer: United Healthcare Medicare |
$778.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,121.00
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
IP
|
$3,225.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
3417801401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,022.08 |
| Max. Negotiated Rate |
$3,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,160.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,096.00
|
| Rate for Payer: Altius Commercial |
$3,096.00
|
| Rate for Payer: Beech Street Commercial |
$3,160.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,647.72
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,128.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,160.50
|
| Rate for Payer: Entrust Commercial |
$3,063.75
|
| Rate for Payer: First Choice Health Commercial |
$3,063.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,063.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,128.50
|
| Rate for Payer: HealthUtah PPO |
$3,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,128.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,022.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,160.50
|
| Rate for Payer: PacificSource Commercial |
$2,902.50
|
| Rate for Payer: PHCS PPO |
$3,160.50
|
| Rate for Payer: Three Rivers PPO |
$2,418.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,128.50
|
| Rate for Payer: United Healthcare Commercial |
$2,805.75
|
| Rate for Payer: United Healthcare Medicare |
$2,128.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,063.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,063.75
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
OP
|
$3,225.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
3417801401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,776.98 |
| Max. Negotiated Rate |
$3,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,160.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,128.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,096.00
|
| Rate for Payer: Altius Commercial |
$3,096.00
|
| Rate for Payer: Beech Street Commercial |
$3,160.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,647.72
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,128.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,160.50
|
| Rate for Payer: Entrust Commercial |
$3,063.75
|
| Rate for Payer: First Choice Health Commercial |
$3,063.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,063.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,870.50
|
| Rate for Payer: HealthUtah PPO |
$3,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,128.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,776.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,160.50
|
| Rate for Payer: PacificSource Commercial |
$2,902.50
|
| Rate for Payer: PHCS PPO |
$3,160.50
|
| Rate for Payer: Three Rivers PPO |
$2,418.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,870.50
|
| Rate for Payer: United Healthcare Commercial |
$2,805.75
|
| Rate for Payer: United Healthcare Medicare |
$1,870.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,160.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,063.75
|
|
|
HC THYROID UPTAKE MEASUREMENT - NM THYROID UPTAKE
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
3417801201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$404.98 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Aetna of WY Medicare |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$705.60
|
| Rate for Payer: Altius Commercial |
$705.60
|
| Rate for Payer: Beech Street Commercial |
$720.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$603.44
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: Entrust Commercial |
$698.25
|
| Rate for Payer: First Choice Health Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.30
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$404.98
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$720.30
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$426.30
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$426.30
|
| Rate for Payer: WINHealth Partners Commercial |
$720.30
|
| Rate for Payer: Wise Provider Network Commercial |
$698.25
|
|
|
HC THYROID UPTAKE MEASUREMENT - NM THYROID UPTAKE
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
3417801201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$460.84 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$705.60
|
| Rate for Payer: Altius Commercial |
$705.60
|
| Rate for Payer: Beech Street Commercial |
$720.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$603.44
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: Entrust Commercial |
$698.25
|
| Rate for Payer: First Choice Health Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$485.10
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$460.84
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$720.30
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$485.10
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$485.10
|
| Rate for Payer: WINHealth Partners Commercial |
$698.25
|
| Rate for Payer: Wise Provider Network Commercial |
$698.25
|
|
|
HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3028636401
|
|
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 TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3028636401
|
|
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 TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3008636401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3008636401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
9429940701
|
|
Hospital Revenue Code
|
942
|
| 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 TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
9429940701
|
|
Hospital Revenue Code
|
942
|
| 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 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
9429940601
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
9429940601
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC TOMOSYNTHESIS MAM UNILAT OR BILAT DIAGNOSTIC
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS G0279
|
| Hospital Charge Code |
401G027901
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC TOMOSYNTHESIS MAM UNILAT OR BILAT DIAGNOSTIC
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS G0279
|
| Hospital Charge Code |
401G027901
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC TOTAL CORTISOL - CORTISOL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253301
|
|
Hospital Revenue Code
|
301
|
| 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 TOTAL CORTISOL - CORTISOL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253301
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
