|
HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86689
|
| Hospital Charge Code |
3028668901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| 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 |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| 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 |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC HTLV I - HTLV-I ANTIBODY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
3028668701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC HTLV I - HTLV-I ANTIBODY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
3028668701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC HTLV-II - HTLV-II ANTIBODY
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86688
|
| Hospital Charge Code |
3028668801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HTLV-II - HTLV-II ANTIBODY
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86688
|
| Hospital Charge Code |
3028668801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3417845201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,942.40 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,011.90
|
| Rate for Payer: Aetna of WY Medicare |
$4,722.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,868.80
|
| Rate for Payer: Altius Commercial |
$6,868.80
|
| Rate for Payer: Beech Street Commercial |
$7,011.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,874.26
|
| Rate for Payer: Cash Price |
$5,008.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,940.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,011.90
|
| Rate for Payer: Entrust Commercial |
$6,797.25
|
| Rate for Payer: First Choice Health Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,149.90
|
| Rate for Payer: HealthUtah PPO |
$7,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,940.35
|
| Rate for Payer: Multiplan Medicare/VA |
$3,942.40
|
| Rate for Payer: One Health Plan of WY PPO |
$7,011.90
|
| Rate for Payer: PacificSource Commercial |
$6,439.50
|
| Rate for Payer: PHCS PPO |
$7,011.90
|
| Rate for Payer: Three Rivers PPO |
$5,366.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,149.90
|
| Rate for Payer: United Healthcare Commercial |
$6,224.85
|
| Rate for Payer: United Healthcare Medicare |
$4,149.90
|
| Rate for Payer: WINHealth Partners Commercial |
$7,011.90
|
| Rate for Payer: Wise Provider Network Commercial |
$6,797.25
|
|
|
HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3417845201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$4,486.18 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,011.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,868.80
|
| Rate for Payer: Altius Commercial |
$6,868.80
|
| Rate for Payer: Beech Street Commercial |
$7,011.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,874.26
|
| Rate for Payer: Cash Price |
$5,008.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,940.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,011.90
|
| Rate for Payer: Entrust Commercial |
$6,797.25
|
| Rate for Payer: First Choice Health Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,722.30
|
| Rate for Payer: HealthUtah PPO |
$7,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,940.35
|
| Rate for Payer: Multiplan Medicare/VA |
$4,486.18
|
| Rate for Payer: One Health Plan of WY PPO |
$7,011.90
|
| Rate for Payer: PacificSource Commercial |
$6,439.50
|
| Rate for Payer: PHCS PPO |
$7,011.90
|
| Rate for Payer: Three Rivers PPO |
$5,366.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,722.30
|
| Rate for Payer: United Healthcare Commercial |
$6,224.85
|
| Rate for Payer: United Healthcare Medicare |
$4,722.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,797.25
|
| Rate for Payer: Wise Provider Network Commercial |
$6,797.25
|
|
|
HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST EXERCISE W MYOCARD PERF
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3417845206
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,942.40 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,011.90
|
| Rate for Payer: Aetna of WY Medicare |
$4,722.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,868.80
|
| Rate for Payer: Altius Commercial |
$6,868.80
|
| Rate for Payer: Beech Street Commercial |
$7,011.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,874.26
|
| Rate for Payer: Cash Price |
$5,008.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,940.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,011.90
|
| Rate for Payer: Entrust Commercial |
$6,797.25
|
| Rate for Payer: First Choice Health Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,149.90
|
| Rate for Payer: HealthUtah PPO |
$7,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,940.35
|
| Rate for Payer: Multiplan Medicare/VA |
$3,942.40
|
| Rate for Payer: One Health Plan of WY PPO |
$7,011.90
|
| Rate for Payer: PacificSource Commercial |
$6,439.50
|
| Rate for Payer: PHCS PPO |
$7,011.90
|
| Rate for Payer: Three Rivers PPO |
$5,366.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,149.90
|
| Rate for Payer: United Healthcare Commercial |
$6,224.85
|
| Rate for Payer: United Healthcare Medicare |
$4,149.90
|
| Rate for Payer: WINHealth Partners Commercial |
$7,011.90
|
| Rate for Payer: Wise Provider Network Commercial |
$6,797.25
|
|
|
HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST EXERCISE W MYOCARD PERF
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
3417845206
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$4,486.18 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,011.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,868.80
|
| Rate for Payer: Altius Commercial |
$6,868.80
|
| Rate for Payer: Beech Street Commercial |
$7,011.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,874.26
|
| Rate for Payer: Cash Price |
$5,008.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,940.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,011.90
|
| Rate for Payer: Entrust Commercial |
$6,797.25
|
| Rate for Payer: First Choice Health Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,797.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,722.30
|
| Rate for Payer: HealthUtah PPO |
$7,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,940.35
|
| Rate for Payer: Multiplan Medicare/VA |
$4,486.18
|
| Rate for Payer: One Health Plan of WY PPO |
$7,011.90
|
| Rate for Payer: PacificSource Commercial |
$6,439.50
|
| Rate for Payer: PHCS PPO |
$7,011.90
|
| Rate for Payer: Three Rivers PPO |
$5,366.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,722.30
|
| Rate for Payer: United Healthcare Commercial |
$6,224.85
|
| Rate for Payer: United Healthcare Medicare |
$4,722.30
|
| Rate for Payer: WINHealth Partners Commercial |
$6,797.25
|
| Rate for Payer: Wise Provider Network Commercial |
$6,797.25
|
|
|
HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT REST
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
3417845101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,429.62 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,797.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,720.00
|
| Rate for Payer: Altius Commercial |
$3,720.00
|
| Rate for Payer: Beech Street Commercial |
$3,797.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,181.38
|
| Rate for Payer: Cash Price |
$2,712.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,758.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,797.50
|
| Rate for Payer: Entrust Commercial |
$3,681.25
|
| Rate for Payer: First Choice Health Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,557.50
|
| Rate for Payer: HealthUtah PPO |
$3,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,758.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,429.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,797.50
|
| Rate for Payer: PacificSource Commercial |
$3,487.50
|
| Rate for Payer: PHCS PPO |
$3,797.50
|
| Rate for Payer: Three Rivers PPO |
$2,906.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,557.50
|
| Rate for Payer: United Healthcare Commercial |
$3,371.25
|
| Rate for Payer: United Healthcare Medicare |
$2,557.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,681.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,681.25
|
|
|
HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT REST
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
3417845101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,135.12 |
| Max. Negotiated Rate |
$3,875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,797.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,557.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,720.00
|
| Rate for Payer: Altius Commercial |
$3,720.00
|
| Rate for Payer: Beech Street Commercial |
$3,797.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,181.38
|
| Rate for Payer: Cash Price |
$2,712.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,758.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,797.50
|
| Rate for Payer: Entrust Commercial |
$3,681.25
|
| Rate for Payer: First Choice Health Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,681.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,247.50
|
| Rate for Payer: HealthUtah PPO |
$3,875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,758.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,135.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,797.50
|
| Rate for Payer: PacificSource Commercial |
$3,487.50
|
| Rate for Payer: PHCS PPO |
$3,797.50
|
| Rate for Payer: Three Rivers PPO |
$2,906.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,247.50
|
| Rate for Payer: United Healthcare Commercial |
$3,371.25
|
| Rate for Payer: United Healthcare Medicare |
$2,247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,797.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,681.25
|
|
|
HC HYMENOTOMY SIMPLE INCISION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 56442
|
| Hospital Charge Code |
5105644201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Aetna of WY Medicare |
$216.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.24
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$180.73
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.24
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$190.24
|
| Rate for Payer: WINHealth Partners Commercial |
$321.44
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC HYMENOTOMY SIMPLE INCISION
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 56442
|
| Hospital Charge Code |
5105644201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.48
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$205.66
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$216.48
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$216.48
|
| Rate for Payer: WINHealth Partners Commercial |
$311.60
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
6369075001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$104.69
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$110.20
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
6369075001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$119.13
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.40
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$125.40
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC IA-2 AUTOANTIBODIES LC
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
3028634102
|
|
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 IA-2 AUTOANTIBODIES LC
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
3028634102
|
|
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 IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
3068732401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC IAAD IA CLOSTRIDIUM DIFFICILE TOXIN - C. DIFFICILE TOXINS (BY EIA)
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
3068732401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC IAAD IA ESCHERICHIA COLI 0157 - ESCHERICHIA COLI 0157 ANTIGEN, EIA
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 87335
|
| Hospital Charge Code |
3068733501
|
|
Hospital Revenue Code
|
306
|
| 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 IAAD IA ESCHERICHIA COLI 0157 - ESCHERICHIA COLI 0157 ANTIGEN, EIA
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 87335
|
| Hospital Charge Code |
3068733501
|
|
Hospital Revenue Code
|
306
|
| 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 IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
3068735001
|
|
Hospital Revenue Code
|
306
|
| 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 IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
3068735001
|
|
Hospital Revenue Code
|
306
|
| 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 IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
