|
HC INCISION DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
5101006001
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
HC INCISION DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
5101006001
|
|
Hospital Revenue Code
|
510
|
| 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 INCISION DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
7611006001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INCISION DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
7611006001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INCISION LABIAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
5104080601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.38
|
| Rate for Payer: Aetna of WY Medicare |
$20.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.76
|
| Rate for Payer: Altius Commercial |
$29.76
|
| Rate for Payer: Beech Street Commercial |
$30.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.45
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.07
|
| Rate for Payer: Cigna of WY Commercial |
$30.38
|
| Rate for Payer: Entrust Commercial |
$29.45
|
| Rate for Payer: First Choice Health Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.98
|
| Rate for Payer: HealthUtah PPO |
$31.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.07
|
| Rate for Payer: Multiplan Medicare/VA |
$17.08
|
| Rate for Payer: One Health Plan of WY PPO |
$30.38
|
| Rate for Payer: PacificSource Commercial |
$27.90
|
| Rate for Payer: PHCS PPO |
$30.38
|
| Rate for Payer: Three Rivers PPO |
$23.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.98
|
| Rate for Payer: United Healthcare Commercial |
$26.97
|
| Rate for Payer: United Healthcare Medicare |
$17.98
|
| Rate for Payer: WINHealth Partners Commercial |
$30.38
|
| Rate for Payer: Wise Provider Network Commercial |
$29.45
|
|
|
HC INCISION LABIAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
5104080601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.76
|
| Rate for Payer: Altius Commercial |
$29.76
|
| Rate for Payer: Beech Street Commercial |
$30.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.45
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.07
|
| Rate for Payer: Cigna of WY Commercial |
$30.38
|
| Rate for Payer: Entrust Commercial |
$29.45
|
| Rate for Payer: First Choice Health Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.46
|
| Rate for Payer: HealthUtah PPO |
$31.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.07
|
| Rate for Payer: Multiplan Medicare/VA |
$19.44
|
| Rate for Payer: One Health Plan of WY PPO |
$30.38
|
| Rate for Payer: PacificSource Commercial |
$27.90
|
| Rate for Payer: PHCS PPO |
$30.38
|
| Rate for Payer: Three Rivers PPO |
$23.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.46
|
| Rate for Payer: United Healthcare Commercial |
$26.97
|
| Rate for Payer: United Healthcare Medicare |
$20.46
|
| Rate for Payer: WINHealth Partners Commercial |
$29.45
|
| Rate for Payer: Wise Provider Network Commercial |
$29.45
|
|
|
HC INCISION LINGUAL FRENUM FRENOTOMY
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
5104101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.66
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$94.68
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.66
|
| Rate for Payer: United Healthcare Commercial |
$131.37
|
| Rate for Payer: United Healthcare Medicare |
$99.66
|
| Rate for Payer: WINHealth Partners Commercial |
$143.45
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC INCISION LINGUAL FRENUM FRENOTOMY
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
5104101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Aetna of WY Medicare |
$99.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.96
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.97
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.58
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$83.20
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$87.58
|
| Rate for Payer: United Healthcare Commercial |
$131.37
|
| Rate for Payer: United Healthcare Medicare |
$87.58
|
| Rate for Payer: WINHealth Partners Commercial |
$147.98
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC INDIUM IN-111 AUTOLOGOUS WHITE BLOOD CELLS
|
Facility
|
OP
|
$6,570.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
343A957001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,620.07 |
| Max. Negotiated Rate |
$6,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,438.60
|
| Rate for Payer: Aetna of WY Medicare |
$4,336.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,307.20
|
| Rate for Payer: Altius Commercial |
$6,307.20
|
| Rate for Payer: Beech Street Commercial |
$6,438.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,393.97
|
| Rate for Payer: Cash Price |
$4,599.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,372.90
|
| Rate for Payer: Cigna of WY Commercial |
$6,438.60
|
| Rate for Payer: Entrust Commercial |
$6,241.50
|
| Rate for Payer: First Choice Health Commercial |
$6,241.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,241.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,810.60
|
| Rate for Payer: HealthUtah PPO |
$6,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,372.90
|
| Rate for Payer: Multiplan Medicare/VA |
$3,620.07
|
| Rate for Payer: One Health Plan of WY PPO |
$6,438.60
|
| Rate for Payer: PacificSource Commercial |
$5,913.00
|
| Rate for Payer: PHCS PPO |
$6,438.60
|
| Rate for Payer: Three Rivers PPO |
$4,927.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,810.60
|
| Rate for Payer: United Healthcare Commercial |
$5,715.90
|
| Rate for Payer: United Healthcare Medicare |
$3,810.60
|
| Rate for Payer: WINHealth Partners Commercial |
$6,438.60
|
| Rate for Payer: Wise Provider Network Commercial |
$6,241.50
|
|
|
HC INDIUM IN-111 AUTOLOGOUS WHITE BLOOD CELLS
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
343A957001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4,119.39 |
| Max. Negotiated Rate |
$6,570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,438.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,307.20
|
| Rate for Payer: Altius Commercial |
$6,307.20
|
| Rate for Payer: Beech Street Commercial |
$6,438.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,393.97
|
| Rate for Payer: Cash Price |
$4,599.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,372.90
|
| Rate for Payer: Cigna of WY Commercial |
$6,438.60
|
| Rate for Payer: Entrust Commercial |
$6,241.50
|
| Rate for Payer: First Choice Health Commercial |
$6,241.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,241.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,336.20
|
| Rate for Payer: HealthUtah PPO |
$6,570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,372.90
|
| Rate for Payer: Multiplan Medicare/VA |
$4,119.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,438.60
|
| Rate for Payer: PacificSource Commercial |
$5,913.00
|
| Rate for Payer: PHCS PPO |
$6,438.60
|
| Rate for Payer: Three Rivers PPO |
$4,927.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,336.20
|
| Rate for Payer: United Healthcare Commercial |
$5,715.90
|
| Rate for Payer: United Healthcare Medicare |
$4,336.20
|
| Rate for Payer: WINHealth Partners Commercial |
$6,241.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,241.50
|
|
|
HC INDUCTION HOUR
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
7210000004
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC INDUCTION HOUR
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
7210000004
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC INF AG DETECT BY NUCLEIC ACID (DNA OR RNA); (SARS-COV-2)
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS U0005
|
| Hospital Charge Code |
300U000501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC INF AG DETECT BY NUCLEIC ACID (DNA OR RNA); (SARS-COV-2)
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS U0005
|
| Hospital Charge Code |
300U000501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA GENITALIUM
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA GENITALIUM
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); (SARS-COV-2)
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS U0003
|
| Hospital Charge Code |
300U000301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); (SARS-COV-2)
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS U0003
|
| Hospital Charge Code |
300U000301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC INFECTIOUS AGENT GENOTYPE BY NUCLEIC ACID CMV
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 87910
|
| Hospital Charge Code |
3068791001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,267.30 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,254.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,518.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,208.00
|
| Rate for Payer: Altius Commercial |
$2,208.00
|
| Rate for Payer: Beech Street Commercial |
$2,254.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,888.30
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,231.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,254.00
|
| Rate for Payer: Entrust Commercial |
$2,185.00
|
| Rate for Payer: First Choice Health Commercial |
$2,185.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,185.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,334.00
|
| Rate for Payer: HealthUtah PPO |
$2,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,231.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,267.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,254.00
|
| Rate for Payer: PacificSource Commercial |
$2,070.00
|
| Rate for Payer: PHCS PPO |
$2,254.00
|
| Rate for Payer: Three Rivers PPO |
$1,725.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,334.00
|
| Rate for Payer: United Healthcare Commercial |
$2,001.00
|
| Rate for Payer: United Healthcare Medicare |
$1,334.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,254.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,185.00
|
|
|
HC INFECTIOUS AGENT GENOTYPE BY NUCLEIC ACID CMV
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 87910
|
| Hospital Charge Code |
3068791001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,442.10 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,254.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,208.00
|
| Rate for Payer: Altius Commercial |
$2,208.00
|
| Rate for Payer: Beech Street Commercial |
$2,254.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,888.30
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,231.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,254.00
|
| Rate for Payer: Entrust Commercial |
$2,185.00
|
| Rate for Payer: First Choice Health Commercial |
$2,185.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,185.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,518.00
|
| Rate for Payer: HealthUtah PPO |
$2,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,231.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,442.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,254.00
|
| Rate for Payer: PacificSource Commercial |
$2,070.00
|
| Rate for Payer: PHCS PPO |
$2,254.00
|
| Rate for Payer: Three Rivers PPO |
$1,725.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,518.00
|
| Rate for Payer: United Healthcare Commercial |
$2,001.00
|
| Rate for Payer: United Healthcare Medicare |
$1,518.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,185.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,185.00
|
|
|
HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - BABESIA MICROTI BY PCR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3068779810
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - BABESIA MICROTI BY PCR
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3068779810
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - BK VIRUS, DNA, URINE, QUANTITATIVE
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$316.82 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$563.50
|
| Rate for Payer: Aetna of WY Medicare |
$379.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.00
|
| Rate for Payer: Altius Commercial |
$552.00
|
| Rate for Payer: Beech Street Commercial |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.08
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$557.75
|
| Rate for Payer: Cigna of WY Commercial |
$563.50
|
| Rate for Payer: Entrust Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$333.50
|
| Rate for Payer: HealthUtah PPO |
$575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$557.75
|
| Rate for Payer: Multiplan Medicare/VA |
$316.82
|
| Rate for Payer: One Health Plan of WY PPO |
$563.50
|
| Rate for Payer: PacificSource Commercial |
$517.50
|
| Rate for Payer: PHCS PPO |
$563.50
|
| Rate for Payer: Three Rivers PPO |
$431.25
|
| Rate for Payer: TriWest Veterans Administration |
$333.50
|
| Rate for Payer: United Healthcare Commercial |
$500.25
|
| Rate for Payer: United Healthcare Medicare |
$333.50
|
| Rate for Payer: WINHealth Partners Commercial |
$563.50
|
| Rate for Payer: Wise Provider Network Commercial |
$546.25
|
|
|
HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - BK VIRUS, DNA, URINE, QUANTITATIVE
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$360.52 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$563.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.00
|
| Rate for Payer: Altius Commercial |
$552.00
|
| Rate for Payer: Beech Street Commercial |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.08
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$557.75
|
| Rate for Payer: Cigna of WY Commercial |
$563.50
|
| Rate for Payer: Entrust Commercial |
$546.25
|
| Rate for Payer: First Choice Health Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$546.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.50
|
| Rate for Payer: HealthUtah PPO |
$575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$557.75
|
| Rate for Payer: Multiplan Medicare/VA |
$360.52
|
| Rate for Payer: One Health Plan of WY PPO |
$563.50
|
| Rate for Payer: PacificSource Commercial |
$517.50
|
| Rate for Payer: PHCS PPO |
$563.50
|
| Rate for Payer: Three Rivers PPO |
$431.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.50
|
| Rate for Payer: United Healthcare Commercial |
$500.25
|
| Rate for Payer: United Healthcare Medicare |
$379.50
|
| Rate for Payer: WINHealth Partners Commercial |
$546.25
|
| Rate for Payer: Wise Provider Network Commercial |
$546.25
|
|
|
HC INFECTIOUS DETECT AGENT NOS, DNA, AMP - BORDETELLA PERTUSSIS PCR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
3068779802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
