|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - SM/RVP ANTIBODY
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$172.42
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$181.50
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY - SM/RVP ANTIBODY
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$181.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
| Rate for Payer: Altius Commercial |
$264.00
|
| Rate for Payer: Beech Street Commercial |
$269.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: Entrust Commercial |
$261.25
|
| Rate for Payer: First Choice Health Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$151.52
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$269.50
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.50
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$159.50
|
| Rate for Payer: WINHealth Partners Commercial |
$269.50
|
| Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
|
HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
3008124001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
3008124001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3008124101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$507.87 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$793.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$777.60
|
| Rate for Payer: Altius Commercial |
$777.60
|
| Rate for Payer: Beech Street Commercial |
$793.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$665.01
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$785.70
|
| Rate for Payer: Cigna of WY Commercial |
$793.80
|
| Rate for Payer: Entrust Commercial |
$769.50
|
| Rate for Payer: First Choice Health Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$534.60
|
| Rate for Payer: HealthUtah PPO |
$810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$785.70
|
| Rate for Payer: Multiplan Medicare/VA |
$507.87
|
| Rate for Payer: One Health Plan of WY PPO |
$793.80
|
| Rate for Payer: PacificSource Commercial |
$729.00
|
| Rate for Payer: PHCS PPO |
$793.80
|
| Rate for Payer: Three Rivers PPO |
$607.50
|
| Rate for Payer: TriWest Veterans Administration |
$534.60
|
| Rate for Payer: United Healthcare Commercial |
$704.70
|
| Rate for Payer: United Healthcare Medicare |
$534.60
|
| Rate for Payer: WINHealth Partners Commercial |
$769.50
|
| Rate for Payer: Wise Provider Network Commercial |
$769.50
|
|
|
HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3008124101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$446.31 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$793.80
|
| Rate for Payer: Aetna of WY Medicare |
$534.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$777.60
|
| Rate for Payer: Altius Commercial |
$777.60
|
| Rate for Payer: Beech Street Commercial |
$793.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$665.01
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$785.70
|
| Rate for Payer: Cigna of WY Commercial |
$793.80
|
| Rate for Payer: Entrust Commercial |
$769.50
|
| Rate for Payer: First Choice Health Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.80
|
| Rate for Payer: HealthUtah PPO |
$810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$785.70
|
| Rate for Payer: Multiplan Medicare/VA |
$446.31
|
| Rate for Payer: One Health Plan of WY PPO |
$793.80
|
| Rate for Payer: PacificSource Commercial |
$729.00
|
| Rate for Payer: PHCS PPO |
$793.80
|
| Rate for Payer: Three Rivers PPO |
$607.50
|
| Rate for Payer: TriWest Veterans Administration |
$469.80
|
| Rate for Payer: United Healthcare Commercial |
$704.70
|
| Rate for Payer: United Healthcare Medicare |
$469.80
|
| Rate for Payer: WINHealth Partners Commercial |
$793.80
|
| Rate for Payer: Wise Provider Network Commercial |
$769.50
|
|
|
HC FAC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT/BILAT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
5106921001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC FAC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT/BILAT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
5106921001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.78
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.69
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.78
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$21.78
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
9169084601
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$87.48 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: Optum Behavioral Health Commercial |
$87.48
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
9169084601
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC FATS/LIPIDS, FECES, QUALITATIVE - FECAL FAT QUALITATIVE
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
3018270501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC FATS/LIPIDS, FECES, QUALITATIVE - FECAL FAT QUALITATIVE
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
3018270501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC FATS/LIPIDS, FECES, QUANTITATIVE - FECAL FAT QUANTITATIVE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
3018271001
|
|
Hospital Revenue Code
|
301
|
| 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 FATS/LIPIDS, FECES, QUANTITATIVE - FECAL FAT QUANTITATIVE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
3018271001
|
|
Hospital Revenue Code
|
301
|
| 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 FECAL BLOOD SCRN IMMUNOASSAY
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
300G032801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.16 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.90
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$166.16
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$174.90
|
| Rate for Payer: WINHealth Partners Commercial |
$251.75
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC FECAL BLOOD SCRN IMMUNOASSAY
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
300G032801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Aetna of WY Medicare |
$174.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.70
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$146.02
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$153.70
|
| Rate for Payer: WINHealth Partners Commercial |
$259.70
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Hospital Charge Code |
9727681901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$160.51 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.96
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$160.51
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$168.96
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$168.96
|
| Rate for Payer: WINHealth Partners Commercial |
$243.20
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 76819 26
|
| Hospital Charge Code |
9727681901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$141.06 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Aetna of WY Medicare |
$168.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.48
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$141.06
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.48
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$148.48
|
| Rate for Payer: WINHealth Partners Commercial |
$250.88
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC FETAL BIOPHYS PROF,W/O NST
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
4027681902
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC FETAL BIOPHYS PROF,W/O NST
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
4027681902
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.90 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$785.96
|
| Rate for Payer: Aetna of WY Medicare |
$529.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$769.92
|
| Rate for Payer: Altius Commercial |
$769.92
|
| Rate for Payer: Beech Street Commercial |
$785.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$658.44
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$777.94
|
| Rate for Payer: Cigna of WY Commercial |
$785.96
|
| Rate for Payer: Entrust Commercial |
$761.90
|
| Rate for Payer: First Choice Health Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.16
|
| Rate for Payer: HealthUtah PPO |
$802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$777.94
|
| Rate for Payer: Multiplan Medicare/VA |
$441.90
|
| Rate for Payer: One Health Plan of WY PPO |
$785.96
|
| Rate for Payer: PacificSource Commercial |
$721.80
|
| Rate for Payer: PHCS PPO |
$785.96
|
| Rate for Payer: Three Rivers PPO |
$601.50
|
| Rate for Payer: TriWest Veterans Administration |
$465.16
|
| Rate for Payer: United Healthcare Commercial |
$697.74
|
| Rate for Payer: United Healthcare Medicare |
$465.16
|
| Rate for Payer: WINHealth Partners Commercial |
$785.96
|
| Rate for Payer: Wise Provider Network Commercial |
$761.90
|
|
|
HC FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$502.85 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$785.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$769.92
|
| Rate for Payer: Altius Commercial |
$769.92
|
| Rate for Payer: Beech Street Commercial |
$785.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$658.44
|
| Rate for Payer: Cash Price |
$561.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$777.94
|
| Rate for Payer: Cigna of WY Commercial |
$785.96
|
| Rate for Payer: Entrust Commercial |
$761.90
|
| Rate for Payer: First Choice Health Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$761.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$529.32
|
| Rate for Payer: HealthUtah PPO |
$802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$777.94
|
| Rate for Payer: Multiplan Medicare/VA |
$502.85
|
| Rate for Payer: One Health Plan of WY PPO |
$785.96
|
| Rate for Payer: PacificSource Commercial |
$721.80
|
| Rate for Payer: PHCS PPO |
$785.96
|
| Rate for Payer: Three Rivers PPO |
$601.50
|
| Rate for Payer: TriWest Veterans Administration |
$529.32
|
| Rate for Payer: United Healthcare Commercial |
$697.74
|
| Rate for Payer: United Healthcare Medicare |
$529.32
|
| Rate for Payer: WINHealth Partners Commercial |
$761.90
|
| Rate for Payer: Wise Provider Network Commercial |
$761.90
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS
|
Facility
|
IP
|
$6,760.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
3008142001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4,238.52 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,624.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,489.60
|
| Rate for Payer: Altius Commercial |
$6,489.60
|
| Rate for Payer: Beech Street Commercial |
$6,624.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,549.96
|
| Rate for Payer: Cash Price |
$4,732.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,557.20
|
| Rate for Payer: Cigna of WY Commercial |
$6,624.80
|
| Rate for Payer: Entrust Commercial |
$6,422.00
|
| Rate for Payer: First Choice Health Commercial |
$6,422.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,422.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,461.60
|
| Rate for Payer: HealthUtah PPO |
$6,760.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,557.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4,238.52
|
| Rate for Payer: One Health Plan of WY PPO |
$6,624.80
|
| Rate for Payer: PacificSource Commercial |
$6,084.00
|
| Rate for Payer: PHCS PPO |
$6,624.80
|
| Rate for Payer: Three Rivers PPO |
$5,070.00
|
| Rate for Payer: TriWest Veterans Administration |
$4,461.60
|
| Rate for Payer: United Healthcare Commercial |
$5,881.20
|
| Rate for Payer: United Healthcare Medicare |
$4,461.60
|
| Rate for Payer: WINHealth Partners Commercial |
$6,422.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,422.00
|
|
|
HC FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS
|
Facility
|
OP
|
$6,760.00
|
|
|
Service Code
|
HCPCS 81420
|
| Hospital Charge Code |
3008142001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,724.76 |
| Max. Negotiated Rate |
$6,760.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,624.80
|
| Rate for Payer: Aetna of WY Medicare |
$4,461.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,489.60
|
| Rate for Payer: Altius Commercial |
$6,489.60
|
| Rate for Payer: Beech Street Commercial |
$6,624.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,549.96
|
| Rate for Payer: Cash Price |
$4,732.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,557.20
|
| Rate for Payer: Cigna of WY Commercial |
$6,624.80
|
| Rate for Payer: Entrust Commercial |
$6,422.00
|
| Rate for Payer: First Choice Health Commercial |
$6,422.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,422.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,920.80
|
| Rate for Payer: HealthUtah PPO |
$6,760.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,557.20
|
| Rate for Payer: Multiplan Medicare/VA |
$3,724.76
|
| Rate for Payer: One Health Plan of WY PPO |
$6,624.80
|
| Rate for Payer: PacificSource Commercial |
$6,084.00
|
| Rate for Payer: PHCS PPO |
$6,624.80
|
| Rate for Payer: Three Rivers PPO |
$5,070.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,920.80
|
| Rate for Payer: United Healthcare Commercial |
$5,881.20
|
| Rate for Payer: United Healthcare Medicare |
$3,920.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6,624.80
|
| Rate for Payer: Wise Provider Network Commercial |
$6,422.00
|
|
|
HC FETAL CONGENITAL ABNORMALITIES ARUP
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 81511
|
| Hospital Charge Code |
3108151101
|
|
Hospital Revenue Code
|
310
|
| 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
|
|
