|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.24 |
| 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 Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.10
|
| 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 |
$17.10
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.24
|
| 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 |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$17.10
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.20
|
| 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 |
$29.10
|
| 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 |
$18.30
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$17.38
|
| 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 |
$18.30
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$18.30
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC CHLAMYDIA, ANTIBODY - CHLAMYDIA ANTIBODIES
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
3028663101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.23 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$67.32
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.94
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.14
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$55.23
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.14
|
| Rate for Payer: United Healthcare Commercial |
$97.41
|
| Rate for Payer: United Healthcare Medicare |
$58.14
|
| Rate for Payer: WINHealth Partners Commercial |
$99.96
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC CHLAMYDIA, ANTIBODY - CHLAMYDIA ANTIBODIES
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
3028663101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$65.28
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.94
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.22
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$59.11
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.22
|
| Rate for Payer: United Healthcare Commercial |
$97.41
|
| Rate for Payer: United Healthcare Medicare |
$62.22
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC CHLAMYDIA CULTURE ANY SOURCE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 87110
|
| Hospital Charge Code |
3068711001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$98.52 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$108.80
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.70
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$98.52
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.70
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Medicare |
$103.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC CHLAMYDIA CULTURE ANY SOURCE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 87110
|
| Hospital Charge Code |
3068711001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.90
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$92.06
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.90
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Medicare |
$96.90
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC CHLAMYDIA, IGM, ANTIBODY - CHLAMYDIA ANTIBODY, IGM
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3028663201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.09 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$109.44
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.31
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$99.09
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$104.31
|
| Rate for Payer: WINHealth Partners Commercial |
$162.45
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC CHLAMYDIA, IGM, ANTIBODY - CHLAMYDIA ANTIBODY, IGM
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3028663201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$112.86
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.47
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$92.60
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.47
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$97.47
|
| Rate for Payer: WINHealth Partners Commercial |
$167.58
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.08
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.42
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$70.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$74.42
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$106.92
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.34
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$87.72
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$92.34
|
| Rate for Payer: United Healthcare Commercial |
$154.71
|
| Rate for Payer: United Healthcare Medicare |
$92.34
|
| Rate for Payer: WINHealth Partners Commercial |
$158.76
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$103.68
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.82
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$93.88
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.82
|
| Rate for Payer: United Healthcare Commercial |
$154.71
|
| Rate for Payer: United Healthcare Medicare |
$98.82
|
| Rate for Payer: WINHealth Partners Commercial |
$153.90
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC CHP BLOOD DRAW
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
3000000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.24 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$30.08
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.67
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$27.24
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.67
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
| Rate for Payer: United Healthcare Medicare |
$28.67
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC CHP BLOOD DRAW
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
3000000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.79
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$25.45
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.79
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
| Rate for Payer: United Healthcare Medicare |
$26.79
|
| Rate for Payer: WINHealth Partners Commercial |
$46.06
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC CHROMOGRANIN A ARUP
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$203.98 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$344.96
|
| Rate for Payer: Aetna of WY Medicare |
$225.28
|
| Rate for Payer: Altius Commercial |
$337.92
|
| Rate for Payer: Beech Street Commercial |
$344.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$341.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$341.44
|
| Rate for Payer: Cigna of WY Commercial |
$344.96
|
| Rate for Payer: Entrust Commercial |
$334.40
|
| Rate for Payer: First Choice Health Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.72
|
| Rate for Payer: HealthUtah PPO |
$352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$341.44
|
| Rate for Payer: Multiplan Medicare/VA |
$203.98
|
| Rate for Payer: One Health Plan of WY PPO |
$344.96
|
| Rate for Payer: PacificSource Commercial |
$316.80
|
| Rate for Payer: PHCS PPO |
$344.96
|
| Rate for Payer: Three Rivers PPO |
$264.00
|
| Rate for Payer: TriWest Veterans Administration |
$214.72
|
| Rate for Payer: United Healthcare Commercial |
$336.16
|
| Rate for Payer: United Healthcare Medicare |
$214.72
|
| Rate for Payer: WINHealth Partners Commercial |
$334.40
|
| Rate for Payer: Wise Provider Network Commercial |
$334.40
|
|
|
HC CHROMOGRANIN A ARUP
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$344.96
|
| Rate for Payer: Aetna of WY Medicare |
$232.32
|
| Rate for Payer: Altius Commercial |
$337.92
|
| Rate for Payer: Beech Street Commercial |
$344.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$341.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$341.44
|
| Rate for Payer: Cigna of WY Commercial |
$344.96
|
| Rate for Payer: Entrust Commercial |
$334.40
|
| Rate for Payer: First Choice Health Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.64
|
| Rate for Payer: HealthUtah PPO |
$352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$341.44
|
| Rate for Payer: Multiplan Medicare/VA |
$190.61
|
| Rate for Payer: One Health Plan of WY PPO |
$344.96
|
| Rate for Payer: PacificSource Commercial |
$316.80
|
| Rate for Payer: PHCS PPO |
$344.96
|
| Rate for Payer: Three Rivers PPO |
$264.00
|
| Rate for Payer: TriWest Veterans Administration |
$200.64
|
| Rate for Payer: United Healthcare Commercial |
$336.16
|
| Rate for Payer: United Healthcare Medicare |
$200.64
|
| Rate for Payer: WINHealth Partners Commercial |
$344.96
|
| Rate for Payer: Wise Provider Network Commercial |
$334.40
|
|
|
HC CHROMOSOME ANALYSIS 15-20 CELLS
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3108826201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$458.38 |
| Max. Negotiated Rate |
$791.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$775.18
|
| Rate for Payer: Aetna of WY Medicare |
$506.24
|
| Rate for Payer: Altius Commercial |
$759.36
|
| Rate for Payer: Beech Street Commercial |
$775.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$767.27
|
| Rate for Payer: Cash Price |
$553.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$767.27
|
| Rate for Payer: Cigna of WY Commercial |
$775.18
|
| Rate for Payer: Entrust Commercial |
$751.45
|
| Rate for Payer: First Choice Health Commercial |
$751.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$751.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$482.51
|
| Rate for Payer: HealthUtah PPO |
$791.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$767.27
|
| Rate for Payer: Multiplan Medicare/VA |
$458.38
|
| Rate for Payer: One Health Plan of WY PPO |
$775.18
|
| Rate for Payer: PacificSource Commercial |
$711.90
|
| Rate for Payer: PHCS PPO |
$775.18
|
| Rate for Payer: Three Rivers PPO |
$593.25
|
| Rate for Payer: TriWest Veterans Administration |
$482.51
|
| Rate for Payer: United Healthcare Commercial |
$755.40
|
| Rate for Payer: United Healthcare Medicare |
$482.51
|
| Rate for Payer: WINHealth Partners Commercial |
$751.45
|
| Rate for Payer: Wise Provider Network Commercial |
$751.45
|
|
|
HC CHROMOSOME ANALYSIS 15-20 CELLS
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3108826201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$428.33 |
| Max. Negotiated Rate |
$791.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$775.18
|
| Rate for Payer: Aetna of WY Medicare |
$522.06
|
| Rate for Payer: Altius Commercial |
$759.36
|
| Rate for Payer: Beech Street Commercial |
$775.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$767.27
|
| Rate for Payer: Cash Price |
$553.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$767.27
|
| Rate for Payer: Cigna of WY Commercial |
$775.18
|
| Rate for Payer: Entrust Commercial |
$751.45
|
| Rate for Payer: First Choice Health Commercial |
$751.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$751.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.87
|
| Rate for Payer: HealthUtah PPO |
$791.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$767.27
|
| Rate for Payer: Multiplan Medicare/VA |
$428.33
|
| Rate for Payer: One Health Plan of WY PPO |
$775.18
|
| Rate for Payer: PacificSource Commercial |
$711.90
|
| Rate for Payer: PHCS PPO |
$775.18
|
| Rate for Payer: Three Rivers PPO |
$593.25
|
| Rate for Payer: TriWest Veterans Administration |
$450.87
|
| Rate for Payer: United Healthcare Commercial |
$755.40
|
| Rate for Payer: United Healthcare Medicare |
$450.87
|
| Rate for Payer: WINHealth Partners Commercial |
$775.18
|
| Rate for Payer: Wise Provider Network Commercial |
$751.45
|
|
|
HC CHROMOSOME ANALYSIS 20-25 CELLS
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
3108826401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$527.92 |
| Max. Negotiated Rate |
$911.00 |
| Rate for Payer: United Healthcare Commercial |
$870.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.78
|
| Rate for Payer: Aetna of WY Medicare |
$583.04
|
| Rate for Payer: Altius Commercial |
$874.56
|
| Rate for Payer: Beech Street Commercial |
$892.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$883.67
|
| Rate for Payer: Cash Price |
$637.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.67
|
| Rate for Payer: Cigna of WY Commercial |
$892.78
|
| Rate for Payer: Entrust Commercial |
$865.45
|
| Rate for Payer: First Choice Health Commercial |
$865.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$865.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$555.71
|
| Rate for Payer: HealthUtah PPO |
$911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.67
|
| Rate for Payer: Multiplan Medicare/VA |
$527.92
|
| Rate for Payer: One Health Plan of WY PPO |
$892.78
|
| Rate for Payer: PacificSource Commercial |
$819.90
|
| Rate for Payer: PHCS PPO |
$892.78
|
| Rate for Payer: Three Rivers PPO |
$683.25
|
| Rate for Payer: TriWest Veterans Administration |
$555.71
|
| Rate for Payer: United Healthcare Medicare |
$555.71
|
| Rate for Payer: WINHealth Partners Commercial |
$865.45
|
| Rate for Payer: Wise Provider Network Commercial |
$865.45
|
|
|
HC CHROMOSOME ANALYSIS 20-25 CELLS
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
3108826401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.78
|
| Rate for Payer: Aetna of WY Medicare |
$601.26
|
| Rate for Payer: Altius Commercial |
$874.56
|
| Rate for Payer: Beech Street Commercial |
$892.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$883.67
|
| Rate for Payer: Cash Price |
$637.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.67
|
| Rate for Payer: Cigna of WY Commercial |
$892.78
|
| Rate for Payer: Entrust Commercial |
$865.45
|
| Rate for Payer: First Choice Health Commercial |
$865.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$865.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$519.27
|
| Rate for Payer: HealthUtah PPO |
$911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.67
|
| Rate for Payer: Multiplan Medicare/VA |
$493.31
|
| Rate for Payer: One Health Plan of WY PPO |
$892.78
|
| Rate for Payer: PacificSource Commercial |
$819.90
|
| Rate for Payer: PHCS PPO |
$892.78
|
| Rate for Payer: Three Rivers PPO |
$683.25
|
| Rate for Payer: TriWest Veterans Administration |
$519.27
|
| Rate for Payer: United Healthcare Commercial |
$870.00
|
| Rate for Payer: United Healthcare Medicare |
$519.27
|
| Rate for Payer: WINHealth Partners Commercial |
$892.78
|
| Rate for Payer: Wise Provider Network Commercial |
$865.45
|
|
|
HC CHROMOSOME ANALYSIS 45 CELLS
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
3108826301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$548.79 |
| Max. Negotiated Rate |
$947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$928.06
|
| Rate for Payer: Aetna of WY Medicare |
$606.08
|
| Rate for Payer: Altius Commercial |
$909.12
|
| Rate for Payer: Beech Street Commercial |
$928.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$918.59
|
| Rate for Payer: Cash Price |
$662.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$918.59
|
| Rate for Payer: Cigna of WY Commercial |
$928.06
|
| Rate for Payer: Entrust Commercial |
$899.65
|
| Rate for Payer: First Choice Health Commercial |
$899.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$899.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.67
|
| Rate for Payer: HealthUtah PPO |
$947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$918.59
|
| Rate for Payer: Multiplan Medicare/VA |
$548.79
|
| Rate for Payer: One Health Plan of WY PPO |
$928.06
|
| Rate for Payer: PacificSource Commercial |
$852.30
|
| Rate for Payer: PHCS PPO |
$928.06
|
| Rate for Payer: Three Rivers PPO |
$710.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.67
|
| Rate for Payer: United Healthcare Commercial |
$904.38
|
| Rate for Payer: United Healthcare Medicare |
$577.67
|
| Rate for Payer: WINHealth Partners Commercial |
$899.65
|
| Rate for Payer: Wise Provider Network Commercial |
$899.65
|
|
|
HC CHROMOSOME ANALYSIS 45 CELLS
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
3108826301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$928.06
|
| Rate for Payer: Aetna of WY Medicare |
$625.02
|
| Rate for Payer: Altius Commercial |
$909.12
|
| Rate for Payer: Beech Street Commercial |
$928.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$918.59
|
| Rate for Payer: Cash Price |
$662.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$918.59
|
| Rate for Payer: Cigna of WY Commercial |
$928.06
|
| Rate for Payer: Entrust Commercial |
$899.65
|
| Rate for Payer: First Choice Health Commercial |
$899.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$899.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.79
|
| Rate for Payer: HealthUtah PPO |
$947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$918.59
|
| Rate for Payer: Multiplan Medicare/VA |
$512.80
|
| Rate for Payer: One Health Plan of WY PPO |
$928.06
|
| Rate for Payer: PacificSource Commercial |
$852.30
|
| Rate for Payer: PHCS PPO |
$928.06
|
| Rate for Payer: Three Rivers PPO |
$710.25
|
| Rate for Payer: TriWest Veterans Administration |
$539.79
|
| Rate for Payer: United Healthcare Commercial |
$904.38
|
| Rate for Payer: United Healthcare Medicare |
$539.79
|
| Rate for Payer: WINHealth Partners Commercial |
$928.06
|
| Rate for Payer: Wise Provider Network Commercial |
$899.65
|
|
|
HC CHROMOSOME ANALYSIS KARYOTYP EA STUDY
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
3108828001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.26 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$206.78
|
| Rate for Payer: Aetna of WY Medicare |
$139.26
|
| Rate for Payer: Altius Commercial |
$202.56
|
| Rate for Payer: Beech Street Commercial |
$206.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.67
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$204.67
|
| Rate for Payer: Cigna of WY Commercial |
$206.78
|
| Rate for Payer: Entrust Commercial |
$200.45
|
| Rate for Payer: First Choice Health Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.27
|
| Rate for Payer: HealthUtah PPO |
$211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$204.67
|
| Rate for Payer: Multiplan Medicare/VA |
$114.26
|
| Rate for Payer: One Health Plan of WY PPO |
$206.78
|
| Rate for Payer: PacificSource Commercial |
$189.90
|
| Rate for Payer: PHCS PPO |
$206.78
|
| Rate for Payer: Three Rivers PPO |
$158.25
|
| Rate for Payer: TriWest Veterans Administration |
$120.27
|
| Rate for Payer: United Healthcare Commercial |
$201.50
|
| Rate for Payer: United Healthcare Medicare |
$120.27
|
| Rate for Payer: WINHealth Partners Commercial |
$206.78
|
| Rate for Payer: Wise Provider Network Commercial |
$200.45
|
|
|
HC CHROMOSOME ANALYSIS KARYOTYP EA STUDY
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
3108828001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$206.78
|
| Rate for Payer: Aetna of WY Medicare |
$135.04
|
| Rate for Payer: Altius Commercial |
$202.56
|
| Rate for Payer: Beech Street Commercial |
$206.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.67
|
| Rate for Payer: Cash Price |
$147.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$204.67
|
| Rate for Payer: Cigna of WY Commercial |
$206.78
|
| Rate for Payer: Entrust Commercial |
$200.45
|
| Rate for Payer: First Choice Health Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.71
|
| Rate for Payer: HealthUtah PPO |
$211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$204.67
|
| Rate for Payer: Multiplan Medicare/VA |
$122.27
|
| Rate for Payer: One Health Plan of WY PPO |
$206.78
|
| Rate for Payer: PacificSource Commercial |
$189.90
|
| Rate for Payer: PHCS PPO |
$206.78
|
| Rate for Payer: Three Rivers PPO |
$158.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.71
|
| Rate for Payer: United Healthcare Commercial |
$201.50
|
| Rate for Payer: United Healthcare Medicare |
$128.71
|
| Rate for Payer: WINHealth Partners Commercial |
$200.45
|
| Rate for Payer: Wise Provider Network Commercial |
$200.45
|
|
|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.54
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$120.21
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.54
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$126.54
|
| Rate for Payer: WINHealth Partners Commercial |
$217.56
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
