|
HC HEMOPHILUS INFLUENZA - HAEMOPHILUS INFLUENZAE B AB IGG
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86684
|
| Hospital Charge Code |
3028668401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC HEPARIN ASSAY - HEPARIN LEVEL
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
3058552002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$536.08 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.30
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$536.08
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.30
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$564.30
|
| Rate for Payer: WINHealth Partners Commercial |
$812.25
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC HEPARIN ASSAY - HEPARIN LEVEL
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
3058552002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Aetna of WY Medicare |
$564.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.90
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$471.10
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$495.90
|
| Rate for Payer: WINHealth Partners Commercial |
$837.90
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC HEPARIN ASSAY - LOW MOLECULAR WGT HEPARIN
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
3058552001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Aetna of WY Medicare |
$564.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.90
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$471.10
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$495.90
|
| Rate for Payer: WINHealth Partners Commercial |
$837.90
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC HEPARIN ASSAY - LOW MOLECULAR WGT HEPARIN
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
3058552001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$536.08 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.30
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$536.08
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.30
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$564.30
|
| Rate for Payer: WINHealth Partners Commercial |
$812.25
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$305.80 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.90
|
| Rate for Payer: Aetna of WY Medicare |
$366.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.80
|
| Rate for Payer: Altius Commercial |
$532.80
|
| Rate for Payer: Beech Street Commercial |
$543.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.66
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.35
|
| Rate for Payer: Cigna of WY Commercial |
$543.90
|
| Rate for Payer: Entrust Commercial |
$527.25
|
| Rate for Payer: First Choice Health Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.90
|
| Rate for Payer: HealthUtah PPO |
$555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.35
|
| Rate for Payer: Multiplan Medicare/VA |
$305.80
|
| Rate for Payer: One Health Plan of WY PPO |
$543.90
|
| Rate for Payer: PacificSource Commercial |
$499.50
|
| Rate for Payer: PHCS PPO |
$543.90
|
| Rate for Payer: Three Rivers PPO |
$416.25
|
| Rate for Payer: TriWest Veterans Administration |
$321.90
|
| Rate for Payer: United Healthcare Commercial |
$482.85
|
| Rate for Payer: United Healthcare Medicare |
$321.90
|
| Rate for Payer: WINHealth Partners Commercial |
$543.90
|
| Rate for Payer: Wise Provider Network Commercial |
$527.25
|
|
|
HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$347.98 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.80
|
| Rate for Payer: Altius Commercial |
$532.80
|
| Rate for Payer: Beech Street Commercial |
$543.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.66
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.35
|
| Rate for Payer: Cigna of WY Commercial |
$543.90
|
| Rate for Payer: Entrust Commercial |
$527.25
|
| Rate for Payer: First Choice Health Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$366.30
|
| Rate for Payer: HealthUtah PPO |
$555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.35
|
| Rate for Payer: Multiplan Medicare/VA |
$347.98
|
| Rate for Payer: One Health Plan of WY PPO |
$543.90
|
| Rate for Payer: PacificSource Commercial |
$499.50
|
| Rate for Payer: PHCS PPO |
$543.90
|
| Rate for Payer: Three Rivers PPO |
$416.25
|
| Rate for Payer: TriWest Veterans Administration |
$366.30
|
| Rate for Payer: United Healthcare Commercial |
$482.85
|
| Rate for Payer: United Healthcare Medicare |
$366.30
|
| Rate for Payer: WINHealth Partners Commercial |
$527.25
|
| Rate for Payer: Wise Provider Network Commercial |
$527.25
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.20
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$49.59
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$52.20
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.40
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.43
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY - STUDENT
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670602
|
|
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 HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY - STUDENT
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670602
|
|
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 HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.70
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.26
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$128.70
|
| Rate for Payer: WINHealth Partners Commercial |
$185.25
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.10
|
| Rate for Payer: Aetna of WY Medicare |
$128.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.20
|
| Rate for Payer: Altius Commercial |
$187.20
|
| Rate for Payer: Beech Street Commercial |
$191.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.10
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.15
|
| Rate for Payer: Cigna of WY Commercial |
$191.10
|
| Rate for Payer: Entrust Commercial |
$185.25
|
| Rate for Payer: First Choice Health Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.10
|
| Rate for Payer: HealthUtah PPO |
$195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.15
|
| Rate for Payer: Multiplan Medicare/VA |
$107.44
|
| Rate for Payer: One Health Plan of WY PPO |
$191.10
|
| Rate for Payer: PacificSource Commercial |
$175.50
|
| Rate for Payer: PHCS PPO |
$191.10
|
| Rate for Payer: Three Rivers PPO |
$146.25
|
| Rate for Payer: TriWest Veterans Administration |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$169.65
|
| Rate for Payer: United Healthcare Medicare |
$113.10
|
| Rate for Payer: WINHealth Partners Commercial |
$191.10
|
| Rate for Payer: Wise Provider Network Commercial |
$185.25
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$964.25 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,436.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,015.00
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$964.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,015.00
|
| Rate for Payer: United Healthcare Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare Medicare |
$1,015.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,097.25 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,436.75
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,155.00
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,097.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,155.00
|
| Rate for Payer: United Healthcare Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare Medicare |
$1,155.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
