|
HC VASCULAR STUDY - AORTOILIAC DUPLEX
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
9219397801
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.86 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$602.70
|
| Rate for Payer: Aetna of WY Medicare |
$405.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$590.40
|
| Rate for Payer: Altius Commercial |
$590.40
|
| Rate for Payer: Beech Street Commercial |
$602.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$504.92
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$596.55
|
| Rate for Payer: Cigna of WY Commercial |
$602.70
|
| Rate for Payer: Entrust Commercial |
$584.25
|
| Rate for Payer: First Choice Health Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.70
|
| Rate for Payer: HealthUtah PPO |
$615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$596.55
|
| Rate for Payer: Multiplan Medicare/VA |
$338.86
|
| Rate for Payer: One Health Plan of WY PPO |
$602.70
|
| Rate for Payer: PacificSource Commercial |
$553.50
|
| Rate for Payer: PHCS PPO |
$602.70
|
| Rate for Payer: Three Rivers PPO |
$461.25
|
| Rate for Payer: TriWest Veterans Administration |
$356.70
|
| Rate for Payer: United Healthcare Commercial |
$535.05
|
| Rate for Payer: United Healthcare Medicare |
$356.70
|
| Rate for Payer: WINHealth Partners Commercial |
$602.70
|
| Rate for Payer: Wise Provider Network Commercial |
$584.25
|
|
|
HC VASCULAR STUDY - AORTOILIAC DUPLEX
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
9219397801
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$602.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$590.40
|
| Rate for Payer: Altius Commercial |
$590.40
|
| Rate for Payer: Beech Street Commercial |
$602.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$504.92
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$596.55
|
| Rate for Payer: Cigna of WY Commercial |
$602.70
|
| Rate for Payer: Entrust Commercial |
$584.25
|
| Rate for Payer: First Choice Health Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.90
|
| Rate for Payer: HealthUtah PPO |
$615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$596.55
|
| Rate for Payer: Multiplan Medicare/VA |
$385.60
|
| Rate for Payer: One Health Plan of WY PPO |
$602.70
|
| Rate for Payer: PacificSource Commercial |
$553.50
|
| Rate for Payer: PHCS PPO |
$602.70
|
| Rate for Payer: Three Rivers PPO |
$461.25
|
| Rate for Payer: TriWest Veterans Administration |
$405.90
|
| Rate for Payer: United Healthcare Commercial |
$535.05
|
| Rate for Payer: United Healthcare Medicare |
$405.90
|
| Rate for Payer: WINHealth Partners Commercial |
$584.25
|
| Rate for Payer: Wise Provider Network Commercial |
$584.25
|
|
|
HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
4029397601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$542.74 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$965.30
|
| Rate for Payer: Aetna of WY Medicare |
$650.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$945.60
|
| Rate for Payer: Altius Commercial |
$945.60
|
| Rate for Payer: Beech Street Commercial |
$965.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$808.68
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$955.45
|
| Rate for Payer: Cigna of WY Commercial |
$965.30
|
| Rate for Payer: Entrust Commercial |
$935.75
|
| Rate for Payer: First Choice Health Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$571.30
|
| Rate for Payer: HealthUtah PPO |
$985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$955.45
|
| Rate for Payer: Multiplan Medicare/VA |
$542.74
|
| Rate for Payer: One Health Plan of WY PPO |
$965.30
|
| Rate for Payer: PacificSource Commercial |
$886.50
|
| Rate for Payer: PHCS PPO |
$965.30
|
| Rate for Payer: Three Rivers PPO |
$738.75
|
| Rate for Payer: TriWest Veterans Administration |
$571.30
|
| Rate for Payer: United Healthcare Commercial |
$856.95
|
| Rate for Payer: United Healthcare Medicare |
$571.30
|
| Rate for Payer: WINHealth Partners Commercial |
$965.30
|
| Rate for Payer: Wise Provider Network Commercial |
$935.75
|
|
|
HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
4029397601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$617.60 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$965.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$945.60
|
| Rate for Payer: Altius Commercial |
$945.60
|
| Rate for Payer: Beech Street Commercial |
$965.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$808.68
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$955.45
|
| Rate for Payer: Cigna of WY Commercial |
$965.30
|
| Rate for Payer: Entrust Commercial |
$935.75
|
| Rate for Payer: First Choice Health Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$650.10
|
| Rate for Payer: HealthUtah PPO |
$985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$955.45
|
| Rate for Payer: Multiplan Medicare/VA |
$617.60
|
| Rate for Payer: One Health Plan of WY PPO |
$965.30
|
| Rate for Payer: PacificSource Commercial |
$886.50
|
| Rate for Payer: PHCS PPO |
$965.30
|
| Rate for Payer: Three Rivers PPO |
$738.75
|
| Rate for Payer: TriWest Veterans Administration |
$650.10
|
| Rate for Payer: United Healthcare Commercial |
$856.95
|
| Rate for Payer: United Healthcare Medicare |
$650.10
|
| Rate for Payer: WINHealth Partners Commercial |
$935.75
|
| Rate for Payer: Wise Provider Network Commercial |
$935.75
|
|
|
HC VASCULAR STUDY - US AORTA ILIAC VESSELS DOPPLER COMPLETE
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
9219397805
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$602.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$590.40
|
| Rate for Payer: Altius Commercial |
$590.40
|
| Rate for Payer: Beech Street Commercial |
$602.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$504.92
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$596.55
|
| Rate for Payer: Cigna of WY Commercial |
$602.70
|
| Rate for Payer: Entrust Commercial |
$584.25
|
| Rate for Payer: First Choice Health Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.90
|
| Rate for Payer: HealthUtah PPO |
$615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$596.55
|
| Rate for Payer: Multiplan Medicare/VA |
$385.60
|
| Rate for Payer: One Health Plan of WY PPO |
$602.70
|
| Rate for Payer: PacificSource Commercial |
$553.50
|
| Rate for Payer: PHCS PPO |
$602.70
|
| Rate for Payer: Three Rivers PPO |
$461.25
|
| Rate for Payer: TriWest Veterans Administration |
$405.90
|
| Rate for Payer: United Healthcare Commercial |
$535.05
|
| Rate for Payer: United Healthcare Medicare |
$405.90
|
| Rate for Payer: WINHealth Partners Commercial |
$584.25
|
| Rate for Payer: Wise Provider Network Commercial |
$584.25
|
|
|
HC VASCULAR STUDY - US AORTA ILIAC VESSELS DOPPLER COMPLETE
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
9219397805
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.86 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$602.70
|
| Rate for Payer: Aetna of WY Medicare |
$405.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$590.40
|
| Rate for Payer: Altius Commercial |
$590.40
|
| Rate for Payer: Beech Street Commercial |
$602.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$504.92
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$596.55
|
| Rate for Payer: Cigna of WY Commercial |
$602.70
|
| Rate for Payer: Entrust Commercial |
$584.25
|
| Rate for Payer: First Choice Health Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$584.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.70
|
| Rate for Payer: HealthUtah PPO |
$615.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$596.55
|
| Rate for Payer: Multiplan Medicare/VA |
$338.86
|
| Rate for Payer: One Health Plan of WY PPO |
$602.70
|
| Rate for Payer: PacificSource Commercial |
$553.50
|
| Rate for Payer: PHCS PPO |
$602.70
|
| Rate for Payer: Three Rivers PPO |
$461.25
|
| Rate for Payer: TriWest Veterans Administration |
$356.70
|
| Rate for Payer: United Healthcare Commercial |
$535.05
|
| Rate for Payer: United Healthcare Medicare |
$356.70
|
| Rate for Payer: WINHealth Partners Commercial |
$602.70
|
| Rate for Payer: Wise Provider Network Commercial |
$584.25
|
|
|
HC VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
5105525001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$224.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$219.84
|
| Rate for Payer: Altius Commercial |
$219.84
|
| Rate for Payer: Beech Street Commercial |
$224.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.01
|
| Rate for Payer: Cash Price |
$160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$222.13
|
| Rate for Payer: Cigna of WY Commercial |
$224.42
|
| Rate for Payer: Entrust Commercial |
$217.55
|
| Rate for Payer: First Choice Health Commercial |
$217.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.14
|
| Rate for Payer: HealthUtah PPO |
$229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$222.13
|
| Rate for Payer: Multiplan Medicare/VA |
$143.58
|
| Rate for Payer: One Health Plan of WY PPO |
$224.42
|
| Rate for Payer: PacificSource Commercial |
$206.10
|
| Rate for Payer: PHCS PPO |
$224.42
|
| Rate for Payer: Three Rivers PPO |
$171.75
|
| Rate for Payer: TriWest Veterans Administration |
$151.14
|
| Rate for Payer: United Healthcare Commercial |
$199.23
|
| Rate for Payer: United Healthcare Medicare |
$151.14
|
| Rate for Payer: WINHealth Partners Commercial |
$217.55
|
| Rate for Payer: Wise Provider Network Commercial |
$217.55
|
|
|
HC VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
5105525001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.18 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$224.42
|
| Rate for Payer: Aetna of WY Medicare |
$151.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$219.84
|
| Rate for Payer: Altius Commercial |
$219.84
|
| Rate for Payer: Beech Street Commercial |
$224.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.01
|
| Rate for Payer: Cash Price |
$160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$222.13
|
| Rate for Payer: Cigna of WY Commercial |
$224.42
|
| Rate for Payer: Entrust Commercial |
$217.55
|
| Rate for Payer: First Choice Health Commercial |
$217.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.82
|
| Rate for Payer: HealthUtah PPO |
$229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$222.13
|
| Rate for Payer: Multiplan Medicare/VA |
$126.18
|
| Rate for Payer: One Health Plan of WY PPO |
$224.42
|
| Rate for Payer: PacificSource Commercial |
$206.10
|
| Rate for Payer: PHCS PPO |
$224.42
|
| Rate for Payer: Three Rivers PPO |
$171.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.82
|
| Rate for Payer: United Healthcare Commercial |
$199.23
|
| Rate for Payer: United Healthcare Medicare |
$132.82
|
| Rate for Payer: WINHealth Partners Commercial |
$224.42
|
| Rate for Payer: Wise Provider Network Commercial |
$217.55
|
|
|
HC VENIPUNCTURE BY PHYSICIAN, OTHER VEIN, UNDER AGE 3 YEARS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS 36406
|
| Hospital Charge Code |
5103640601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.52
|
| Rate for Payer: Altius Commercial |
$11.52
|
| Rate for Payer: Beech Street Commercial |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: Entrust Commercial |
$11.40
|
| Rate for Payer: First Choice Health Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.96
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$6.61
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.76
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$6.96
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$6.96
|
| Rate for Payer: WINHealth Partners Commercial |
$11.76
|
| Rate for Payer: Wise Provider Network Commercial |
$11.40
|
|
|
HC VENIPUNCTURE BY PHYSICIAN, OTHER VEIN, UNDER AGE 3 YEARS
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS 36406
|
| Hospital Charge Code |
5103640601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.52
|
| Rate for Payer: Altius Commercial |
$11.52
|
| Rate for Payer: Beech Street Commercial |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: Entrust Commercial |
$11.40
|
| Rate for Payer: First Choice Health Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.92
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$7.52
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.76
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$7.92
|
| Rate for Payer: WINHealth Partners Commercial |
$11.40
|
| Rate for Payer: Wise Provider Network Commercial |
$11.40
|
|
|
HC VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 36425
|
| Hospital Charge Code |
5103642501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Aetna of WY Medicare |
$27.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
| Rate for Payer: Altius Commercial |
$39.36
|
| Rate for Payer: Beech Street Commercial |
$40.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: Entrust Commercial |
$38.95
|
| Rate for Payer: First Choice Health Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.78
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: Multiplan Medicare/VA |
$22.59
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$40.18
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.78
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$23.78
|
| Rate for Payer: WINHealth Partners Commercial |
$40.18
|
| Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
|
HC VENIPUNCTURE CUTDOWN AGE 1 YR/>
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 36425
|
| Hospital Charge Code |
5103642501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.71 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.36
|
| Rate for Payer: Altius Commercial |
$39.36
|
| Rate for Payer: Beech Street Commercial |
$40.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.66
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: Entrust Commercial |
$38.95
|
| Rate for Payer: First Choice Health Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.06
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: Multiplan Medicare/VA |
$25.71
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$40.18
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.06
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$27.06
|
| Rate for Payer: WINHealth Partners Commercial |
$38.95
|
| Rate for Payer: Wise Provider Network Commercial |
$38.95
|
|
|
HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY LEFT
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
3237582001
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,771.60 |
| Max. Negotiated Rate |
$6,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,708.10
|
| Rate for Payer: Aetna of WY Medicare |
$4,517.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,571.20
|
| Rate for Payer: Altius Commercial |
$6,571.20
|
| Rate for Payer: Beech Street Commercial |
$6,708.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,619.74
|
| Rate for Payer: Cash Price |
$4,791.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,639.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,708.10
|
| Rate for Payer: Entrust Commercial |
$6,502.75
|
| Rate for Payer: First Choice Health Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,970.10
|
| Rate for Payer: HealthUtah PPO |
$6,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,639.65
|
| Rate for Payer: Multiplan Medicare/VA |
$3,771.60
|
| Rate for Payer: One Health Plan of WY PPO |
$6,708.10
|
| Rate for Payer: PacificSource Commercial |
$6,160.50
|
| Rate for Payer: PHCS PPO |
$6,708.10
|
| Rate for Payer: Three Rivers PPO |
$5,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,970.10
|
| Rate for Payer: United Healthcare Commercial |
$5,955.15
|
| Rate for Payer: United Healthcare Medicare |
$3,970.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,708.10
|
| Rate for Payer: Wise Provider Network Commercial |
$6,502.75
|
|
|
HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY LEFT
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
3237582001
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,291.82 |
| Max. Negotiated Rate |
$6,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,708.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,571.20
|
| Rate for Payer: Altius Commercial |
$6,571.20
|
| Rate for Payer: Beech Street Commercial |
$6,708.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,619.74
|
| Rate for Payer: Cash Price |
$4,791.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,639.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,708.10
|
| Rate for Payer: Entrust Commercial |
$6,502.75
|
| Rate for Payer: First Choice Health Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,517.70
|
| Rate for Payer: HealthUtah PPO |
$6,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,639.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4,291.82
|
| Rate for Payer: One Health Plan of WY PPO |
$6,708.10
|
| Rate for Payer: PacificSource Commercial |
$6,160.50
|
| Rate for Payer: PHCS PPO |
$6,708.10
|
| Rate for Payer: Three Rivers PPO |
$5,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,517.70
|
| Rate for Payer: United Healthcare Commercial |
$5,955.15
|
| Rate for Payer: United Healthcare Medicare |
$4,517.70
|
| Rate for Payer: WINHealth Partners Commercial |
$6,502.75
|
| Rate for Payer: Wise Provider Network Commercial |
$6,502.75
|
|
|
HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY RIGHT
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
3237582003
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,771.60 |
| Max. Negotiated Rate |
$6,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,708.10
|
| Rate for Payer: Aetna of WY Medicare |
$4,517.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,571.20
|
| Rate for Payer: Altius Commercial |
$6,571.20
|
| Rate for Payer: Beech Street Commercial |
$6,708.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,619.74
|
| Rate for Payer: Cash Price |
$4,791.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,639.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,708.10
|
| Rate for Payer: Entrust Commercial |
$6,502.75
|
| Rate for Payer: First Choice Health Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,970.10
|
| Rate for Payer: HealthUtah PPO |
$6,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,639.65
|
| Rate for Payer: Multiplan Medicare/VA |
$3,771.60
|
| Rate for Payer: One Health Plan of WY PPO |
$6,708.10
|
| Rate for Payer: PacificSource Commercial |
$6,160.50
|
| Rate for Payer: PHCS PPO |
$6,708.10
|
| Rate for Payer: Three Rivers PPO |
$5,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,970.10
|
| Rate for Payer: United Healthcare Commercial |
$5,955.15
|
| Rate for Payer: United Healthcare Medicare |
$3,970.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,708.10
|
| Rate for Payer: Wise Provider Network Commercial |
$6,502.75
|
|
|
HC VENOGRAM EXTREM UNILAT - IR VENOGRAM LOWER EXTREMITY RIGHT
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
3237582003
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,291.82 |
| Max. Negotiated Rate |
$6,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,708.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,571.20
|
| Rate for Payer: Altius Commercial |
$6,571.20
|
| Rate for Payer: Beech Street Commercial |
$6,708.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,619.74
|
| Rate for Payer: Cash Price |
$4,791.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,639.65
|
| Rate for Payer: Cigna of WY Commercial |
$6,708.10
|
| Rate for Payer: Entrust Commercial |
$6,502.75
|
| Rate for Payer: First Choice Health Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,502.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,517.70
|
| Rate for Payer: HealthUtah PPO |
$6,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,639.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4,291.82
|
| Rate for Payer: One Health Plan of WY PPO |
$6,708.10
|
| Rate for Payer: PacificSource Commercial |
$6,160.50
|
| Rate for Payer: PHCS PPO |
$6,708.10
|
| Rate for Payer: Three Rivers PPO |
$5,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,517.70
|
| Rate for Payer: United Healthcare Commercial |
$5,955.15
|
| Rate for Payer: United Healthcare Medicare |
$4,517.70
|
| Rate for Payer: WINHealth Partners Commercial |
$6,502.75
|
| Rate for Payer: Wise Provider Network Commercial |
$6,502.75
|
|
|
HC VENOUS PROCEDUE
|
Facility
|
IP
|
$1,130.00
|
|
| Hospital Charge Code |
3600000031
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.51 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.80
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.73
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.80
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$708.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$745.80
|
| Rate for Payer: United Healthcare Commercial |
$983.10
|
| Rate for Payer: United Healthcare Medicare |
$745.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,073.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC VENOUS PROCEDUE
|
Facility
|
OP
|
$1,130.00
|
|
| Hospital Charge Code |
3600000031
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$622.63 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Aetna of WY Medicare |
$745.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.80
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.73
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.40
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$622.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$655.40
|
| Rate for Payer: United Healthcare Commercial |
$983.10
|
| Rate for Payer: United Healthcare Medicare |
$655.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC VIRAL CULTURE NON-RESP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3098725202
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC VIRAL CULTURE NON-RESP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3098725202
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC VIRAL IDENTIFICATION ADDITIONAL STUDIES
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| 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 VIRAL IDENTIFICATION ADDITIONAL STUDIES
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| 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 VIRUS ANTIBODIES NES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679001
|
|
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 VIRUS ANTIBODIES NES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679001
|
|
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 VIRUS ANTIBODIES NES - CHIKUNGUNYA FEVER IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679006
|
|
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
|
|
