|
HC HEPATOBIL SYST IMAGE W/DRUG - NM HEPATOBILIARY
|
Facility
|
OP
|
$3,475.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822702
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,914.72 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,293.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,336.00
|
| Rate for Payer: Altius Commercial |
$3,336.00
|
| Rate for Payer: Beech Street Commercial |
$3,405.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,852.98
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: Entrust Commercial |
$3,301.25
|
| Rate for Payer: First Choice Health Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,015.50
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,914.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,405.50
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,015.50
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$2,015.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,405.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,301.25
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG - NM HEPATOBILIARY
|
Facility
|
IP
|
$3,475.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822702
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,178.82 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,336.00
|
| Rate for Payer: Altius Commercial |
$3,336.00
|
| Rate for Payer: Beech Street Commercial |
$3,405.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,852.98
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: Entrust Commercial |
$3,301.25
|
| Rate for Payer: First Choice Health Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,293.50
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,178.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,405.50
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,293.50
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$2,293.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,301.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,301.25
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG - NM HEPATOBILIARY W CHOLECYSTOKININ
|
Facility
|
OP
|
$3,475.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,914.72 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,293.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,336.00
|
| Rate for Payer: Altius Commercial |
$3,336.00
|
| Rate for Payer: Beech Street Commercial |
$3,405.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,852.98
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: Entrust Commercial |
$3,301.25
|
| Rate for Payer: First Choice Health Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,015.50
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,914.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,405.50
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,015.50
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$2,015.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,405.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,301.25
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG - NM HEPATOBILIARY W CHOLECYSTOKININ
|
Facility
|
IP
|
$3,475.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,178.82 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,336.00
|
| Rate for Payer: Altius Commercial |
$3,336.00
|
| Rate for Payer: Beech Street Commercial |
$3,405.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,852.98
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: Entrust Commercial |
$3,301.25
|
| Rate for Payer: First Choice Health Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,293.50
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,178.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,405.50
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,293.50
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$2,293.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,301.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,301.25
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC HEP C AB TEST, CONFIRM - HEPATITIS C VIRUS, RIBA
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 86804
|
| Hospital Charge Code |
3028680401
|
|
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 HEP C AB TEST, CONFIRM - HEPATITIS C VIRUS, RIBA
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 86804
|
| Hospital Charge Code |
3028680401
|
|
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 HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81433
|
| Hospital Charge Code |
3108143301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Aetna of WY Medicare |
$869.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$763.86
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$725.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$763.86
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$763.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,290.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81433
|
| Hospital Charge Code |
3108143301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$825.76 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$869.22
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$825.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$869.22
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$869.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.15
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HEREDITARY BRST CA-RELATED GEN SEQ ANALYSIS 10 GEN
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
HCPCS 81432
|
| Hospital Charge Code |
3108143201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,277.20 |
| Max. Negotiated Rate |
$2,037.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,996.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,955.52
|
| Rate for Payer: Altius Commercial |
$1,955.52
|
| Rate for Payer: Beech Street Commercial |
$1,996.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,672.38
|
| Rate for Payer: Cash Price |
$1,425.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,975.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,996.26
|
| Rate for Payer: Entrust Commercial |
$1,935.15
|
| Rate for Payer: First Choice Health Commercial |
$1,935.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,935.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,344.42
|
| Rate for Payer: HealthUtah PPO |
$2,037.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,975.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,277.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,996.26
|
| Rate for Payer: PacificSource Commercial |
$1,833.30
|
| Rate for Payer: PHCS PPO |
$1,996.26
|
| Rate for Payer: Three Rivers PPO |
$1,527.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,344.42
|
| Rate for Payer: United Healthcare Commercial |
$1,772.19
|
| Rate for Payer: United Healthcare Medicare |
$1,344.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,935.15
|
| Rate for Payer: Wise Provider Network Commercial |
$1,935.15
|
|
|
HC HEREDITARY BRST CA-RELATED GEN SEQ ANALYSIS 10 GEN
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
HCPCS 81432
|
| Hospital Charge Code |
3108143201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,122.39 |
| Max. Negotiated Rate |
$2,037.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,996.26
|
| Rate for Payer: Aetna of WY Medicare |
$1,344.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,955.52
|
| Rate for Payer: Altius Commercial |
$1,955.52
|
| Rate for Payer: Beech Street Commercial |
$1,996.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,672.38
|
| Rate for Payer: Cash Price |
$1,425.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,975.89
|
| Rate for Payer: Cigna of WY Commercial |
$1,996.26
|
| Rate for Payer: Entrust Commercial |
$1,935.15
|
| Rate for Payer: First Choice Health Commercial |
$1,935.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,935.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,181.46
|
| Rate for Payer: HealthUtah PPO |
$2,037.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,975.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,122.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,996.26
|
| Rate for Payer: PacificSource Commercial |
$1,833.30
|
| Rate for Payer: PHCS PPO |
$1,996.26
|
| Rate for Payer: Three Rivers PPO |
$1,527.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,181.46
|
| Rate for Payer: United Healthcare Commercial |
$1,772.19
|
| Rate for Payer: United Healthcare Medicare |
$1,181.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,996.26
|
| Rate for Payer: Wise Provider Network Commercial |
$1,935.15
|
|
|
HC HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN
|
Facility
|
IP
|
$5,205.00
|
|
|
Service Code
|
HCPCS 81436
|
| Hospital Charge Code |
3108143601
|
|
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 HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN
|
Facility
|
OP
|
$5,205.00
|
|
|
Service Code
|
HCPCS 81436
|
| Hospital Charge Code |
3108143601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,867.96 |
| Max. Negotiated Rate |
$5,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,100.90
|
| Rate for Payer: Aetna of WY Medicare |
$3,435.30
|
| 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 |
$3,018.90
|
| Rate for Payer: HealthUtah PPO |
$5,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,048.85
|
| Rate for Payer: Multiplan Medicare/VA |
$2,867.96
|
| 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 |
$3,018.90
|
| Rate for Payer: United Healthcare Commercial |
$4,528.35
|
| Rate for Payer: United Healthcare Medicare |
$3,018.90
|
| Rate for Payer: WINHealth Partners Commercial |
$5,100.90
|
| Rate for Payer: Wise Provider Network Commercial |
$4,944.75
|
|
|
HC HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81438
|
| Hospital Charge Code |
3008143801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$825.76 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$869.22
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$825.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$869.22
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$869.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.15
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81438
|
| Hospital Charge Code |
3008143801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Aetna of WY Medicare |
$869.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$763.86
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$725.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$763.86
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$763.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,290.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81437
|
| Hospital Charge Code |
3008143701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Aetna of WY Medicare |
$869.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$763.86
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$725.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$763.86
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$763.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,290.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
HCPCS 81437
|
| Hospital Charge Code |
3008143701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$825.76 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,290.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,264.32
|
| Rate for Payer: Altius Commercial |
$1,264.32
|
| Rate for Payer: Beech Street Commercial |
$1,290.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,081.26
|
| Rate for Payer: Cash Price |
$921.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,277.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,290.66
|
| Rate for Payer: Entrust Commercial |
$1,251.15
|
| Rate for Payer: First Choice Health Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,251.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$869.22
|
| Rate for Payer: HealthUtah PPO |
$1,317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,277.49
|
| Rate for Payer: Multiplan Medicare/VA |
$825.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,290.66
|
| Rate for Payer: PacificSource Commercial |
$1,185.30
|
| Rate for Payer: PHCS PPO |
$1,290.66
|
| Rate for Payer: Three Rivers PPO |
$987.75
|
| Rate for Payer: TriWest Veterans Administration |
$869.22
|
| Rate for Payer: United Healthcare Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare Medicare |
$869.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.15
|
| Rate for Payer: Wise Provider Network Commercial |
$1,251.15
|
|
|
HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGM ANTIBODY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3028669602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
