|
HC GENOMIC SEQUENCE HEREDITARY COLON CA DSORDER
|
Facility
|
IP
|
$5,205.00
|
|
|
Service Code
|
HCPCS 81435
|
| Hospital Charge Code |
3108143501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,263.54 |
| Max. Negotiated Rate |
$5,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,100.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,996.80
|
| Rate for Payer: Altius Commercial |
$4,996.80
|
| Rate for Payer: Beech Street Commercial |
$5,100.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,273.30
|
| Rate for Payer: Cash Price |
$3,643.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,048.85
|
| Rate for Payer: Cigna of WY Commercial |
$5,100.90
|
| Rate for Payer: Entrust Commercial |
$4,944.75
|
| Rate for Payer: First Choice Health Commercial |
$4,944.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,944.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,435.30
|
| Rate for Payer: HealthUtah PPO |
$5,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,048.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3,263.54
|
| Rate for Payer: One Health Plan of WY PPO |
$5,100.90
|
| Rate for Payer: PacificSource Commercial |
$4,684.50
|
| Rate for Payer: PHCS PPO |
$5,100.90
|
| Rate for Payer: Three Rivers PPO |
$3,903.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,435.30
|
| Rate for Payer: United Healthcare Commercial |
$4,528.35
|
| Rate for Payer: United Healthcare Medicare |
$3,435.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,944.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,944.75
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$625.38 |
| Max. Negotiated Rate |
$1,135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,112.30
|
| Rate for Payer: Aetna of WY Medicare |
$749.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,089.60
|
| Rate for Payer: Altius Commercial |
$1,089.60
|
| Rate for Payer: Beech Street Commercial |
$1,112.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$931.84
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,100.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,112.30
|
| Rate for Payer: Entrust Commercial |
$1,078.25
|
| Rate for Payer: First Choice Health Commercial |
$1,078.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,078.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$658.30
|
| Rate for Payer: HealthUtah PPO |
$1,135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,100.95
|
| Rate for Payer: Multiplan Medicare/VA |
$625.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,112.30
|
| Rate for Payer: PacificSource Commercial |
$1,021.50
|
| Rate for Payer: PHCS PPO |
$1,112.30
|
| Rate for Payer: Three Rivers PPO |
$851.25
|
| Rate for Payer: TriWest Veterans Administration |
$658.30
|
| Rate for Payer: United Healthcare Commercial |
$987.45
|
| Rate for Payer: United Healthcare Medicare |
$658.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,112.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,078.25
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$711.64 |
| Max. Negotiated Rate |
$1,135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,112.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,089.60
|
| Rate for Payer: Altius Commercial |
$1,089.60
|
| Rate for Payer: Beech Street Commercial |
$1,112.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$931.84
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,100.95
|
| Rate for Payer: Cigna of WY Commercial |
$1,112.30
|
| Rate for Payer: Entrust Commercial |
$1,078.25
|
| Rate for Payer: First Choice Health Commercial |
$1,078.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,078.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$749.10
|
| Rate for Payer: HealthUtah PPO |
$1,135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,100.95
|
| Rate for Payer: Multiplan Medicare/VA |
$711.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,112.30
|
| Rate for Payer: PacificSource Commercial |
$1,021.50
|
| Rate for Payer: PHCS PPO |
$1,112.30
|
| Rate for Payer: Three Rivers PPO |
$851.25
|
| Rate for Payer: TriWest Veterans Administration |
$749.10
|
| Rate for Payer: United Healthcare Commercial |
$987.45
|
| Rate for Payer: United Healthcare Medicare |
$749.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,078.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,078.25
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 1 NS5A
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,153.68 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,214.40
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,153.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,748.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 1 NS5A
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,013.84 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,214.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.20
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,013.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.20
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,067.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,803.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 1 NS5B
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,013.84 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,214.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.20
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,013.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.20
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,067.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,803.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 1 NS5B
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790203
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,153.68 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,214.40
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,153.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,748.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 3 NS5A
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,013.84 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,214.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.20
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,013.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.20
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,067.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,803.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GENOTYPE ANALYSIS HEPATITIS C 3 NS5A
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,153.68 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,803.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,766.40
|
| Rate for Payer: Altius Commercial |
$1,766.40
|
| Rate for Payer: Beech Street Commercial |
$1,803.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,510.64
|
| Rate for Payer: Cash Price |
$1,288.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,784.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,803.20
|
| Rate for Payer: Entrust Commercial |
$1,748.00
|
| Rate for Payer: First Choice Health Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,748.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,214.40
|
| Rate for Payer: HealthUtah PPO |
$1,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,784.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,153.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,803.20
|
| Rate for Payer: PacificSource Commercial |
$1,656.00
|
| Rate for Payer: PHCS PPO |
$1,803.20
|
| Rate for Payer: Three Rivers PPO |
$1,380.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,214.40
|
| Rate for Payer: United Healthcare Commercial |
$1,600.80
|
| Rate for Payer: United Healthcare Medicare |
$1,214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,748.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,748.00
|
|
|
HC GIARDIA AG, IF - GIARDIA AND CRYPTOSPORIDIUM ANTIGENS, DFA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
3068726901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC GIARDIA AG, IF - GIARDIA AND CRYPTOSPORIDIUM ANTIGENS, DFA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
3068726901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC GIARDIA LAMBLIA - GIARDIA LAMBLIA ANTIBODY, IFA
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86674
|
| Hospital Charge Code |
3028667401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC GIARDIA LAMBLIA - GIARDIA LAMBLIA ANTIBODY, IFA
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86674
|
| Hospital Charge Code |
3028667401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
3028625801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
3028625801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC GLOSSECTOMY <ONE-HALF TONGUE
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
5104112001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.24 |
| Max. Negotiated Rate |
$1,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,071.14
|
| Rate for Payer: Aetna of WY Medicare |
$721.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,049.28
|
| Rate for Payer: Altius Commercial |
$1,049.28
|
| Rate for Payer: Beech Street Commercial |
$1,071.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$897.35
|
| Rate for Payer: Cash Price |
$765.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,060.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,071.14
|
| Rate for Payer: Entrust Commercial |
$1,038.35
|
| Rate for Payer: First Choice Health Commercial |
$1,038.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,038.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$633.94
|
| Rate for Payer: HealthUtah PPO |
$1,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,060.21
|
| Rate for Payer: Multiplan Medicare/VA |
$602.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,071.14
|
| Rate for Payer: PacificSource Commercial |
$983.70
|
| Rate for Payer: PHCS PPO |
$1,071.14
|
| Rate for Payer: Three Rivers PPO |
$819.75
|
| Rate for Payer: TriWest Veterans Administration |
$633.94
|
| Rate for Payer: United Healthcare Commercial |
$950.91
|
| Rate for Payer: United Healthcare Medicare |
$633.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,071.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,038.35
|
|
|
HC GLOSSECTOMY <ONE-HALF TONGUE
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
5104112001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$685.31 |
| Max. Negotiated Rate |
$1,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,071.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,049.28
|
| Rate for Payer: Altius Commercial |
$1,049.28
|
| Rate for Payer: Beech Street Commercial |
$1,071.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$897.35
|
| Rate for Payer: Cash Price |
$765.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,060.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,071.14
|
| Rate for Payer: Entrust Commercial |
$1,038.35
|
| Rate for Payer: First Choice Health Commercial |
$1,038.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,038.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$721.38
|
| Rate for Payer: HealthUtah PPO |
$1,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,060.21
|
| Rate for Payer: Multiplan Medicare/VA |
$685.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,071.14
|
| Rate for Payer: PacificSource Commercial |
$983.70
|
| Rate for Payer: PHCS PPO |
$1,071.14
|
| Rate for Payer: Three Rivers PPO |
$819.75
|
| Rate for Payer: TriWest Veterans Administration |
$721.38
|
| Rate for Payer: United Healthcare Commercial |
$950.91
|
| Rate for Payer: United Healthcare Medicare |
$721.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,038.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,038.35
|
|
|
HC GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
3018296201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
3018296201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC GLUCOSE, BLOOD BY REAGENT STRIP
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC GLUCOSE, BLOOD BY REAGENT STRIP
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC GLUCOSE TEST - GTT 1 HOUR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
3018295001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC GLUCOSE TEST - GTT 1 HOUR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
3018295001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
3018295101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC GLUCOSE TOLERANCE TEST (GTT) - GTT 2 HOUR
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
3018295101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
