|
HC VIRUS ANTIBODIES NES - CHIKUNGUNYA FEVER IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679006
|
|
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 - COLORADO TICK FEVER, IGG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679004
|
|
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 - COLORADO TICK FEVER, IGG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679004
|
|
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 - COLORADO TICK FEVER, IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679005
|
|
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 - COLORADO TICK FEVER, IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679005
|
|
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 - DENGUE FEVER ANTIBODY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679002
|
|
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 - DENGUE FEVER ANTIBODY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679002
|
|
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 - HANTA VIRUS IGG/IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679003
|
|
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 - HANTA VIRUS IGG/IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679003
|
|
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 - HEPATITIS E IGG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679007
|
|
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 - HEPATITIS E IGG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679007
|
|
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 - HEPATITIS E IGM
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679008
|
|
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 - HEPATITIS E IGM
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679008
|
|
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 - HERPES VIRUS 6 IGG ANTIBODY
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC VIRUS ANTIBODIES NES - HERPES VIRUS 6 IGG ANTIBODY
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC VIRUS ANTIBODIES NES - HERPES VIRUS 6 IGM ANTIBODY
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC VIRUS ANTIBODIES NES - HERPES VIRUS 6 IGM ANTIBODY
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
3028679010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC VIRUS ID,NON-IMMUNOLOGIC METHOD - HSV CULTURE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
3068725501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC VIRUS ID,NON-IMMUNOLOGIC METHOD - HSV CULTURE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
3068725501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC VIRUS INOCULATION SHELL VIAL STAIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3068725401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$116.81 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$139.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$203.52
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.05
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.96
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$116.81
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$122.96
|
| Rate for Payer: United Healthcare Commercial |
$184.44
|
| Rate for Payer: United Healthcare Medicare |
$122.96
|
| Rate for Payer: WINHealth Partners Commercial |
$207.76
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC VIRUS INOCULATION SHELL VIAL STAIN
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
3068725401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$203.52
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.05
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.92
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$132.92
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.92
|
| Rate for Payer: United Healthcare Commercial |
$184.44
|
| Rate for Payer: United Healthcare Medicare |
$139.92
|
| Rate for Payer: WINHealth Partners Commercial |
$201.40
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC VIRUS TISSUE CULTURE BY INOCULATION
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3068725201
|
|
Hospital Revenue Code
|
306
|
| 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 VIRUS TISSUE CULTURE BY INOCULATION
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3068725201
|
|
Hospital Revenue Code
|
306
|
| 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 VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
4609415002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC VITAL CAPACITY TEST - PR VITAL CAPACITY TEST
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
4609415002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
