|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC CHLAMYDIA, ANTIBODY - CHLAMYDIA ANTIBODIES
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
3028663101
|
|
Hospital Revenue Code
|
302
|
| 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 CHLAMYDIA, ANTIBODY - CHLAMYDIA ANTIBODIES
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
3028663101
|
|
Hospital Revenue Code
|
302
|
| 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 CHLAMYDIA CULTURE ANY SOURCE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 87110
|
| Hospital Charge Code |
3068711001
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
HC CHLAMYDIA CULTURE ANY SOURCE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 87110
|
| Hospital Charge Code |
3068711001
|
|
Hospital Revenue Code
|
306
|
| 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 CHLAMYDIA, IGM, ANTIBODY - CHLAMYDIA ANTIBODY, IGM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3028663201
|
|
Hospital Revenue Code
|
302
|
| 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 CHLAMYDIA, IGM, ANTIBODY - CHLAMYDIA ANTIBODY, IGM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
3028663201
|
|
Hospital Revenue Code
|
302
|
| 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 CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| 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 CHP BLOOD DRAW
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
3000000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC CHP BLOOD DRAW
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
3000000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC CHROMOGRANIN A ARUP
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC CHROMOGRANIN A ARUP
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC CHROMOSOME ANALYSIS 15-20 CELLS
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3108826201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$537.90
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$511.00
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$537.90
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
| Rate for Payer: WINHealth Partners Commercial |
$774.25
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
|
HC CHROMOSOME ANALYSIS 15-20 CELLS
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
3108826201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Aetna of WY Medicare |
$537.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.70
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$449.06
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$472.70
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$472.70
|
| Rate for Payer: WINHealth Partners Commercial |
$798.70
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
|
HC CHROMOSOME ANALYSIS 20-25 CELLS
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
3108826401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$589.38 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$921.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$902.40
|
| Rate for Payer: Altius Commercial |
$902.40
|
| Rate for Payer: Beech Street Commercial |
$921.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$771.74
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$911.80
|
| Rate for Payer: Cigna of WY Commercial |
$921.20
|
| Rate for Payer: Entrust Commercial |
$893.00
|
| Rate for Payer: First Choice Health Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$620.40
|
| Rate for Payer: HealthUtah PPO |
$940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$911.80
|
| Rate for Payer: Multiplan Medicare/VA |
$589.38
|
| Rate for Payer: One Health Plan of WY PPO |
$921.20
|
| Rate for Payer: PacificSource Commercial |
$846.00
|
| Rate for Payer: PHCS PPO |
$921.20
|
| Rate for Payer: Three Rivers PPO |
$705.00
|
| Rate for Payer: TriWest Veterans Administration |
$620.40
|
| Rate for Payer: United Healthcare Commercial |
$817.80
|
| Rate for Payer: United Healthcare Medicare |
$620.40
|
| Rate for Payer: WINHealth Partners Commercial |
$893.00
|
| Rate for Payer: Wise Provider Network Commercial |
$893.00
|
|
|
HC CHROMOSOME ANALYSIS 20-25 CELLS
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
3108826401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$517.94 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$921.20
|
| Rate for Payer: Aetna of WY Medicare |
$620.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$902.40
|
| Rate for Payer: Altius Commercial |
$902.40
|
| Rate for Payer: Beech Street Commercial |
$921.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$771.74
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$911.80
|
| Rate for Payer: Cigna of WY Commercial |
$921.20
|
| Rate for Payer: Entrust Commercial |
$893.00
|
| Rate for Payer: First Choice Health Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$893.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$545.20
|
| Rate for Payer: HealthUtah PPO |
$940.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$911.80
|
| Rate for Payer: Multiplan Medicare/VA |
$517.94
|
| Rate for Payer: One Health Plan of WY PPO |
$921.20
|
| Rate for Payer: PacificSource Commercial |
$846.00
|
| Rate for Payer: PHCS PPO |
$921.20
|
| Rate for Payer: Three Rivers PPO |
$705.00
|
| Rate for Payer: TriWest Veterans Administration |
$545.20
|
| Rate for Payer: United Healthcare Commercial |
$817.80
|
| Rate for Payer: United Healthcare Medicare |
$545.20
|
| Rate for Payer: WINHealth Partners Commercial |
$921.20
|
| Rate for Payer: Wise Provider Network Commercial |
$893.00
|
|
|
HC CHROMOSOME ANALYSIS 45 CELLS
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
3108826301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$611.32 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$611.32
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$643.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$643.50
|
| Rate for Payer: WINHealth Partners Commercial |
$926.25
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC CHROMOSOME ANALYSIS 45 CELLS
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 88263
|
| Hospital Charge Code |
3108826301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$537.22 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Aetna of WY Medicare |
$643.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$537.22
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$565.50
|
| Rate for Payer: WINHealth Partners Commercial |
$955.50
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC CHROMOSOME ANALYSIS KARYOTYP EA STUDY
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
3108828001
|
|
Hospital Revenue Code
|
310
|
| 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 CHROMOSOME ANALYSIS KARYOTYP EA STUDY
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
3108828001
|
|
Hospital Revenue Code
|
310
|
| 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
|
|
