|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
3068753601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV 1 RNA QUANT BY PCR
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
3068753601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
3068753602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC HIV-1 QUANT&REVRSE TRNSCRPJ - HIV RNA, QUANTITATIVE, PCR
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
3068753602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
3108137501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,232.06 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,296.90
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,232.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,296.90
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,296.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,866.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
|
HC HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 81375
|
| Hospital Charge Code |
3108137501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,082.72 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,925.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,296.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,886.40
|
| Rate for Payer: Altius Commercial |
$1,886.40
|
| Rate for Payer: Beech Street Commercial |
$1,925.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,613.26
|
| Rate for Payer: Cash Price |
$1,375.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,906.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,925.70
|
| Rate for Payer: Entrust Commercial |
$1,866.75
|
| Rate for Payer: First Choice Health Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,866.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,139.70
|
| Rate for Payer: HealthUtah PPO |
$1,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,906.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,082.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,925.70
|
| Rate for Payer: PacificSource Commercial |
$1,768.50
|
| Rate for Payer: PHCS PPO |
$1,925.70
|
| Rate for Payer: Three Rivers PPO |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,139.70
|
| Rate for Payer: United Healthcare Commercial |
$1,709.55
|
| Rate for Payer: United Healthcare Medicare |
$1,139.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,925.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,866.75
|
|
|
HC HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS 81374
|
| Hospital Charge Code |
3108137401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$304.10 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.10
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$304.10
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$320.10
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
| Rate for Payer: WINHealth Partners Commercial |
$460.75
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS 81374
|
| Hospital Charge Code |
3108137401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Aetna of WY Medicare |
$320.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.30
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$281.30
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$281.30
|
| Rate for Payer: WINHealth Partners Commercial |
$475.30
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC HLA ONE CLASS II ALLELE HIGH RESOLUTION ASSESSMENT
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 81383
|
| Hospital Charge Code |
3108138301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$837.52 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,489.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,003.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,459.20
|
| Rate for Payer: Altius Commercial |
$1,459.20
|
| Rate for Payer: Beech Street Commercial |
$1,489.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,247.92
|
| Rate for Payer: Cash Price |
$1,064.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,474.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,489.60
|
| Rate for Payer: Entrust Commercial |
$1,444.00
|
| Rate for Payer: First Choice Health Commercial |
$1,444.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,444.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$881.60
|
| Rate for Payer: HealthUtah PPO |
$1,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,474.40
|
| Rate for Payer: Multiplan Medicare/VA |
$837.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,489.60
|
| Rate for Payer: PacificSource Commercial |
$1,368.00
|
| Rate for Payer: PHCS PPO |
$1,489.60
|
| Rate for Payer: Three Rivers PPO |
$1,140.00
|
| Rate for Payer: TriWest Veterans Administration |
$881.60
|
| Rate for Payer: United Healthcare Commercial |
$1,322.40
|
| Rate for Payer: United Healthcare Medicare |
$881.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,489.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,444.00
|
|
|
HC HLA ONE CLASS II ALLELE HIGH RESOLUTION ASSESSMENT
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 81383
|
| Hospital Charge Code |
3108138301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,489.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,459.20
|
| Rate for Payer: Altius Commercial |
$1,459.20
|
| Rate for Payer: Beech Street Commercial |
$1,489.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,247.92
|
| Rate for Payer: Cash Price |
$1,064.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,474.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,489.60
|
| Rate for Payer: Entrust Commercial |
$1,444.00
|
| Rate for Payer: First Choice Health Commercial |
$1,444.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,444.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,003.20
|
| Rate for Payer: HealthUtah PPO |
$1,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,474.40
|
| Rate for Payer: Multiplan Medicare/VA |
$953.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,489.60
|
| Rate for Payer: PacificSource Commercial |
$1,368.00
|
| Rate for Payer: PHCS PPO |
$1,489.60
|
| Rate for Payer: Three Rivers PPO |
$1,140.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,003.20
|
| Rate for Payer: United Healthcare Commercial |
$1,322.40
|
| Rate for Payer: United Healthcare Medicare |
$1,003.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,444.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,444.00
|
|
|
HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
3028681201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| 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 |
$139.57
|
| 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 |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| 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 |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86812
|
| Hospital Charge Code |
3028681201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.67 |
| 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 Auto/Workers Compensation |
$163.20
|
| 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 |
$139.57
|
| 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 |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| 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 |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC HOCM 350-399MG/ML IODINE, PER ML
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
255Q996301
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.30
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC HOCM 350-399MG/ML IODINE, PER ML
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
255Q996301
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Aetna of WY Medicare |
$3.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.90
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$2.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.90
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$2.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4.90
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC HOSPITAL OB OBSERVATION PER HR
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037807
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$669.46 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,190.70
|
| Rate for Payer: Aetna of WY Medicare |
$801.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,166.40
|
| Rate for Payer: Altius Commercial |
$1,166.40
|
| Rate for Payer: Beech Street Commercial |
$1,190.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$997.52
|
| Rate for Payer: Cash Price |
$850.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,178.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,190.70
|
| Rate for Payer: Entrust Commercial |
$1,154.25
|
| Rate for Payer: First Choice Health Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.70
|
| Rate for Payer: HealthUtah PPO |
$1,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,178.55
|
| Rate for Payer: Multiplan Medicare/VA |
$669.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,190.70
|
| Rate for Payer: PacificSource Commercial |
$1,093.50
|
| Rate for Payer: PHCS PPO |
$1,190.70
|
| Rate for Payer: Three Rivers PPO |
$911.25
|
| Rate for Payer: TriWest Veterans Administration |
$704.70
|
| Rate for Payer: United Healthcare Commercial |
$1,057.05
|
| Rate for Payer: United Healthcare Medicare |
$704.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,190.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,154.25
|
|
|
HC HOSPITAL OB OBSERVATION PER HR
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037807
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$761.80 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,190.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,166.40
|
| Rate for Payer: Altius Commercial |
$1,166.40
|
| Rate for Payer: Beech Street Commercial |
$1,190.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$997.52
|
| Rate for Payer: Cash Price |
$850.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,178.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,190.70
|
| Rate for Payer: Entrust Commercial |
$1,154.25
|
| Rate for Payer: First Choice Health Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$801.90
|
| Rate for Payer: HealthUtah PPO |
$1,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,178.55
|
| Rate for Payer: Multiplan Medicare/VA |
$761.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,190.70
|
| Rate for Payer: PacificSource Commercial |
$1,093.50
|
| Rate for Payer: PHCS PPO |
$1,190.70
|
| Rate for Payer: Three Rivers PPO |
$911.25
|
| Rate for Payer: TriWest Veterans Administration |
$801.90
|
| Rate for Payer: United Healthcare Commercial |
$1,057.05
|
| Rate for Payer: United Healthcare Medicare |
$801.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,154.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,154.25
|
|
|
HC HOSPITAL OBSERVATION HOURLY PER HR
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$669.46 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,190.70
|
| Rate for Payer: Aetna of WY Medicare |
$801.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,166.40
|
| Rate for Payer: Altius Commercial |
$1,166.40
|
| Rate for Payer: Beech Street Commercial |
$1,190.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$997.52
|
| Rate for Payer: Cash Price |
$850.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,178.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,190.70
|
| Rate for Payer: Entrust Commercial |
$1,154.25
|
| Rate for Payer: First Choice Health Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.70
|
| Rate for Payer: HealthUtah PPO |
$1,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,178.55
|
| Rate for Payer: Multiplan Medicare/VA |
$669.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,190.70
|
| Rate for Payer: PacificSource Commercial |
$1,093.50
|
| Rate for Payer: PHCS PPO |
$1,190.70
|
| Rate for Payer: Three Rivers PPO |
$911.25
|
| Rate for Payer: TriWest Veterans Administration |
$704.70
|
| Rate for Payer: United Healthcare Commercial |
$1,057.05
|
| Rate for Payer: United Healthcare Medicare |
$704.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,190.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,154.25
|
|
|
HC HOSPITAL OBSERVATION HOURLY PER HR
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$761.80 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,190.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,166.40
|
| Rate for Payer: Altius Commercial |
$1,166.40
|
| Rate for Payer: Beech Street Commercial |
$1,190.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$997.52
|
| Rate for Payer: Cash Price |
$850.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,178.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,190.70
|
| Rate for Payer: Entrust Commercial |
$1,154.25
|
| Rate for Payer: First Choice Health Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,154.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$801.90
|
| Rate for Payer: HealthUtah PPO |
$1,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,178.55
|
| Rate for Payer: Multiplan Medicare/VA |
$761.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,190.70
|
| Rate for Payer: PacificSource Commercial |
$1,093.50
|
| Rate for Payer: PHCS PPO |
$1,190.70
|
| Rate for Payer: Three Rivers PPO |
$911.25
|
| Rate for Payer: TriWest Veterans Administration |
$801.90
|
| Rate for Payer: United Healthcare Commercial |
$1,057.05
|
| Rate for Payer: United Healthcare Medicare |
$801.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,154.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,154.25
|
|
|
HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
3018301301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.30
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$191.24
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$201.30
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
3018301301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$201.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.90
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$168.06
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$176.90
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$176.90
|
| Rate for Payer: WINHealth Partners Commercial |
$298.90
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC HSV, DNA, AMP PROBE - HSV PCR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC HSV, DNA, AMP PROBE - HSV PCR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC HSV, DNA, QUANT - HSV DNA, QUANTITATIVE
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 87530
|
| Hospital Charge Code |
3068753001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$396.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$330.60
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$348.00
|
| Rate for Payer: WINHealth Partners Commercial |
$588.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC HSV, DNA, QUANT - HSV DNA, QUANTITATIVE
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 87530
|
| Hospital Charge Code |
3068753001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$376.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$376.20
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
| Rate for Payer: WINHealth Partners Commercial |
$570.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
3028668901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
