|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT WRIST RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT WRIST RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CULTURE AEROBIC BACTERIA FECES
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
3068704501
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE AEROBIC BACTERIA FECES
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
3068704501
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE BACTERIA ANAEROBIC EXCEPT BLOOD
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
3068707501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CULTURE BACTERIA ANAEROBIC EXCEPT BLOOD
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
3068707501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC CULTURE BACTERIA EXCPT URINE BLOOD/STOOL AEROBIC ISOL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707001
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE BACTERIA EXCPT URINE BLOOD/STOOL AEROBIC ISOL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707001
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
3068710101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
3068710101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
3068714001
|
|
Hospital Revenue Code
|
306
|
| 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 CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
3068714001
|
|
Hospital Revenue Code
|
306
|
| 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 CURETTAGE POSTPARTUM
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
7615916001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CURETTAGE POSTPARTUM
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
7615916001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC CURETTAGE POSTPARTUM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
5105916001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC CURETTAGE POSTPARTUM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
5105916001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC CUSTOM WRIST-HAND-FINGER ORTHOTIC RIGID W/O JOINTS
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
274L380801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.10 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.10
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$304.10
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$320.10
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$320.10
|
| Rate for Payer: WINHealth Partners Commercial |
$460.75
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC CUSTOM WRIST-HAND-FINGER ORTHOTIC RIGID W/O JOINTS
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
274L380801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$267.24 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$475.30
|
| Rate for Payer: Aetna of WY Medicare |
$320.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$465.60
|
| Rate for Payer: Altius Commercial |
$465.60
|
| Rate for Payer: Beech Street Commercial |
$475.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$398.18
|
| Rate for Payer: Cash Price |
$339.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$470.45
|
| Rate for Payer: Cigna of WY Commercial |
$475.30
|
| Rate for Payer: Entrust Commercial |
$460.75
|
| Rate for Payer: First Choice Health Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$460.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.30
|
| Rate for Payer: HealthUtah PPO |
$485.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$470.45
|
| Rate for Payer: Multiplan Medicare/VA |
$267.24
|
| Rate for Payer: One Health Plan of WY PPO |
$475.30
|
| Rate for Payer: PacificSource Commercial |
$436.50
|
| Rate for Payer: PHCS PPO |
$475.30
|
| Rate for Payer: Three Rivers PPO |
$363.75
|
| Rate for Payer: TriWest Veterans Administration |
$281.30
|
| Rate for Payer: United Healthcare Commercial |
$421.95
|
| Rate for Payer: United Healthcare Medicare |
$281.30
|
| Rate for Payer: WINHealth Partners Commercial |
$475.30
|
| Rate for Payer: Wise Provider Network Commercial |
$460.75
|
|
|
HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
3028620001
|
|
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 CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
3028620001
|
|
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 CYP2C19 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
3108122501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,432.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,716.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,496.00
|
| Rate for Payer: Altius Commercial |
$2,496.00
|
| Rate for Payer: Beech Street Commercial |
$2,548.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,134.60
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: Entrust Commercial |
$2,470.00
|
| Rate for Payer: First Choice Health Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,508.00
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,432.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,548.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,508.00
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$1,508.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,548.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,470.00
|
|
|
HC CYP2C19 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 81225
|
| Hospital Charge Code |
3108122501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,630.20 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,496.00
|
| Rate for Payer: Altius Commercial |
$2,496.00
|
| Rate for Payer: Beech Street Commercial |
$2,548.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,134.60
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: Entrust Commercial |
$2,470.00
|
| Rate for Payer: First Choice Health Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,716.00
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,630.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,548.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,716.00
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,470.00
|
|
|
HC CYP2D6 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$4,015.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
3108122601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,212.26 |
| Max. Negotiated Rate |
$4,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,934.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,649.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,854.40
|
| Rate for Payer: Altius Commercial |
$3,854.40
|
| Rate for Payer: Beech Street Commercial |
$3,934.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,296.32
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,894.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,934.70
|
| Rate for Payer: Entrust Commercial |
$3,814.25
|
| Rate for Payer: First Choice Health Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,328.70
|
| Rate for Payer: HealthUtah PPO |
$4,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,894.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,212.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3,934.70
|
| Rate for Payer: PacificSource Commercial |
$3,613.50
|
| Rate for Payer: PHCS PPO |
$3,934.70
|
| Rate for Payer: Three Rivers PPO |
$3,011.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,328.70
|
| Rate for Payer: United Healthcare Commercial |
$3,493.05
|
| Rate for Payer: United Healthcare Medicare |
$2,328.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,934.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3,814.25
|
|
|
HC CYP2D6 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$4,015.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
3108122601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,517.40 |
| Max. Negotiated Rate |
$4,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,934.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,854.40
|
| Rate for Payer: Altius Commercial |
$3,854.40
|
| Rate for Payer: Beech Street Commercial |
$3,934.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,296.32
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,894.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,934.70
|
| Rate for Payer: Entrust Commercial |
$3,814.25
|
| Rate for Payer: First Choice Health Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,649.90
|
| Rate for Payer: HealthUtah PPO |
$4,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,894.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,517.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,934.70
|
| Rate for Payer: PacificSource Commercial |
$3,613.50
|
| Rate for Payer: PHCS PPO |
$3,934.70
|
| Rate for Payer: Three Rivers PPO |
$3,011.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,649.90
|
| Rate for Payer: United Healthcare Commercial |
$3,493.05
|
| Rate for Payer: United Healthcare Medicare |
$2,649.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3,814.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,814.25
|
|
|
HC CYSTOSCOPY PROCEDURE
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
3600000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$943.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$787.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$829.40
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$829.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
