|
HC CARDIOVERSION, ELECTIVE;EXTERN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4819296001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,258.06 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,086.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,752.20
|
| Rate for Payer: Altius Commercial |
$4,003.20
|
| Rate for Payer: Beech Street Commercial |
$4,086.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,044.90
|
| Rate for Payer: Cash Price |
$2,919.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,044.90
|
| Rate for Payer: Cigna of WY Commercial |
$4,086.60
|
| Rate for Payer: Entrust Commercial |
$3,961.50
|
| Rate for Payer: First Choice Health Commercial |
$3,961.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,961.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,376.90
|
| Rate for Payer: HealthUtah PPO |
$4,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,044.90
|
| Rate for Payer: Multiplan Medicare/VA |
$2,258.06
|
| Rate for Payer: One Health Plan of WY PPO |
$4,086.60
|
| Rate for Payer: PacificSource Commercial |
$3,753.00
|
| Rate for Payer: PHCS PPO |
$4,086.60
|
| Rate for Payer: Three Rivers PPO |
$3,127.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,376.90
|
| Rate for Payer: United Healthcare Commercial |
$3,982.35
|
| Rate for Payer: United Healthcare Medicare |
$2,376.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,086.60
|
| Rate for Payer: Wise Provider Network Commercial |
$3,961.50
|
|
|
HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL
|
Facility
|
IP
|
$4,170.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,416.52 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,086.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,668.80
|
| Rate for Payer: Altius Commercial |
$4,003.20
|
| Rate for Payer: Beech Street Commercial |
$4,086.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,044.90
|
| Rate for Payer: Cash Price |
$2,919.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,044.90
|
| Rate for Payer: Cigna of WY Commercial |
$4,086.60
|
| Rate for Payer: Entrust Commercial |
$3,961.50
|
| Rate for Payer: First Choice Health Commercial |
$3,961.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,961.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,543.70
|
| Rate for Payer: HealthUtah PPO |
$4,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,044.90
|
| Rate for Payer: Multiplan Medicare/VA |
$2,416.52
|
| Rate for Payer: One Health Plan of WY PPO |
$4,086.60
|
| Rate for Payer: PacificSource Commercial |
$3,753.00
|
| Rate for Payer: PHCS PPO |
$4,086.60
|
| Rate for Payer: Three Rivers PPO |
$3,127.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,543.70
|
| Rate for Payer: United Healthcare Commercial |
$3,982.35
|
| Rate for Payer: United Healthcare Medicare |
$2,543.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,961.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,961.50
|
|
|
HC C-ARM DEVICES
|
Facility
|
IP
|
$272.00
|
|
| Hospital Charge Code |
3600000037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$266.56
|
| Rate for Payer: Aetna of WY Medicare |
$174.08
|
| Rate for Payer: Altius Commercial |
$261.12
|
| Rate for Payer: Beech Street Commercial |
$266.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.84
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.84
|
| Rate for Payer: Cigna of WY Commercial |
$266.56
|
| Rate for Payer: Entrust Commercial |
$258.40
|
| Rate for Payer: First Choice Health Commercial |
$258.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$258.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.92
|
| Rate for Payer: HealthUtah PPO |
$272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.84
|
| Rate for Payer: Multiplan Medicare/VA |
$157.62
|
| Rate for Payer: One Health Plan of WY PPO |
$266.56
|
| Rate for Payer: PacificSource Commercial |
$244.80
|
| Rate for Payer: PHCS PPO |
$266.56
|
| Rate for Payer: Three Rivers PPO |
$204.00
|
| Rate for Payer: TriWest Veterans Administration |
$165.92
|
| Rate for Payer: United Healthcare Commercial |
$259.76
|
| Rate for Payer: United Healthcare Medicare |
$165.92
|
| Rate for Payer: WINHealth Partners Commercial |
$258.40
|
| Rate for Payer: Wise Provider Network Commercial |
$258.40
|
|
|
HC C-ARM DEVICES
|
Facility
|
OP
|
$272.00
|
|
| Hospital Charge Code |
3600000037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$266.56
|
| Rate for Payer: Aetna of WY Medicare |
$179.52
|
| Rate for Payer: Altius Commercial |
$261.12
|
| Rate for Payer: Beech Street Commercial |
$266.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.84
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.84
|
| Rate for Payer: Cigna of WY Commercial |
$266.56
|
| Rate for Payer: Entrust Commercial |
$258.40
|
| Rate for Payer: First Choice Health Commercial |
$258.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$258.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.04
|
| Rate for Payer: HealthUtah PPO |
$272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.84
|
| Rate for Payer: Multiplan Medicare/VA |
$147.29
|
| Rate for Payer: One Health Plan of WY PPO |
$266.56
|
| Rate for Payer: PacificSource Commercial |
$244.80
|
| Rate for Payer: PHCS PPO |
$266.56
|
| Rate for Payer: Three Rivers PPO |
$204.00
|
| Rate for Payer: TriWest Veterans Administration |
$155.04
|
| Rate for Payer: United Healthcare Commercial |
$259.76
|
| Rate for Payer: United Healthcare Medicare |
$155.04
|
| Rate for Payer: WINHealth Partners Commercial |
$266.56
|
| Rate for Payer: Wise Provider Network Commercial |
$258.40
|
|
|
HC CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.60
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.15
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.69
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.15
|
| Rate for Payer: United Healthcare Commercial |
$14.32
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.55
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.12
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$14.32
|
| Rate for Payer: United Healthcare Medicare |
$8.55
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC CASIRIVI AND IMDEVI INFUSION/SUBCUT INJ
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
510M024301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$580.16
|
| Rate for Payer: Aetna of WY Medicare |
$390.72
|
| Rate for Payer: Altius Commercial |
$568.32
|
| Rate for Payer: Beech Street Commercial |
$580.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.24
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$574.24
|
| Rate for Payer: Cigna of WY Commercial |
$580.16
|
| Rate for Payer: Entrust Commercial |
$562.40
|
| Rate for Payer: First Choice Health Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.44
|
| Rate for Payer: HealthUtah PPO |
$592.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$574.24
|
| Rate for Payer: Multiplan Medicare/VA |
$320.57
|
| Rate for Payer: One Health Plan of WY PPO |
$580.16
|
| Rate for Payer: PacificSource Commercial |
$532.80
|
| Rate for Payer: PHCS PPO |
$580.16
|
| Rate for Payer: Three Rivers PPO |
$444.00
|
| Rate for Payer: TriWest Veterans Administration |
$337.44
|
| Rate for Payer: United Healthcare Commercial |
$565.36
|
| Rate for Payer: United Healthcare Medicare |
$337.44
|
| Rate for Payer: WINHealth Partners Commercial |
$580.16
|
| Rate for Payer: Wise Provider Network Commercial |
$562.40
|
|
|
HC CASIRIVI AND IMDEVI INFUSION/SUBCUT INJ
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS M0243
|
| Hospital Charge Code |
510M024301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$343.06 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$580.16
|
| Rate for Payer: Aetna of WY Medicare |
$378.88
|
| Rate for Payer: Altius Commercial |
$568.32
|
| Rate for Payer: Beech Street Commercial |
$580.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.24
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$574.24
|
| Rate for Payer: Cigna of WY Commercial |
$580.16
|
| Rate for Payer: Entrust Commercial |
$562.40
|
| Rate for Payer: First Choice Health Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$361.12
|
| Rate for Payer: HealthUtah PPO |
$592.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$574.24
|
| Rate for Payer: Multiplan Medicare/VA |
$343.06
|
| Rate for Payer: One Health Plan of WY PPO |
$580.16
|
| Rate for Payer: PacificSource Commercial |
$532.80
|
| Rate for Payer: PHCS PPO |
$580.16
|
| Rate for Payer: Three Rivers PPO |
$444.00
|
| Rate for Payer: TriWest Veterans Administration |
$361.12
|
| Rate for Payer: United Healthcare Commercial |
$565.36
|
| Rate for Payer: United Healthcare Medicare |
$361.12
|
| Rate for Payer: WINHealth Partners Commercial |
$562.40
|
| Rate for Payer: Wise Provider Network Commercial |
$562.40
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
3205834001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,111.32
|
| Rate for Payer: Aetna of WY Medicare |
$748.44
|
| Rate for Payer: Altius Commercial |
$1,088.64
|
| Rate for Payer: Beech Street Commercial |
$1,111.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.98
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,099.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,111.32
|
| Rate for Payer: Entrust Commercial |
$1,077.30
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$646.38
|
| Rate for Payer: HealthUtah PPO |
$1,134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,099.98
|
| Rate for Payer: Multiplan Medicare/VA |
$614.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,111.32
|
| Rate for Payer: PacificSource Commercial |
$1,020.60
|
| Rate for Payer: PHCS PPO |
$1,111.32
|
| Rate for Payer: Three Rivers PPO |
$850.50
|
| Rate for Payer: TriWest Veterans Administration |
$646.38
|
| Rate for Payer: United Healthcare Commercial |
$1,082.97
|
| Rate for Payer: United Healthcare Medicare |
$646.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,111.32
|
| Rate for Payer: Wise Provider Network Commercial |
$1,077.30
|
|
|
HC CATH/INJECT HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
3205834001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$657.15 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,111.32
|
| Rate for Payer: Aetna of WY Medicare |
$725.76
|
| Rate for Payer: Altius Commercial |
$1,088.64
|
| Rate for Payer: Beech Street Commercial |
$1,111.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.98
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,099.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,111.32
|
| Rate for Payer: Entrust Commercial |
$1,077.30
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$691.74
|
| Rate for Payer: HealthUtah PPO |
$1,134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,099.98
|
| Rate for Payer: Multiplan Medicare/VA |
$657.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,111.32
|
| Rate for Payer: PacificSource Commercial |
$1,020.60
|
| Rate for Payer: PHCS PPO |
$1,111.32
|
| Rate for Payer: Three Rivers PPO |
$850.50
|
| Rate for Payer: TriWest Veterans Administration |
$691.74
|
| Rate for Payer: United Healthcare Commercial |
$1,082.97
|
| Rate for Payer: United Healthcare Medicare |
$691.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,077.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,077.30
|
|
|
HC CATH INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH
|
Facility
|
IP
|
$5,658.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
4819356701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,278.81 |
| Max. Negotiated Rate |
$5,658.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,544.84
|
| Rate for Payer: Aetna of WY Medicare |
$3,621.12
|
| Rate for Payer: Altius Commercial |
$5,431.68
|
| Rate for Payer: Beech Street Commercial |
$5,544.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,488.26
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,488.26
|
| Rate for Payer: Cigna of WY Commercial |
$5,544.84
|
| Rate for Payer: Entrust Commercial |
$5,375.10
|
| Rate for Payer: First Choice Health Commercial |
$5,375.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,375.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,451.38
|
| Rate for Payer: HealthUtah PPO |
$5,658.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,488.26
|
| Rate for Payer: Multiplan Medicare/VA |
$3,278.81
|
| Rate for Payer: One Health Plan of WY PPO |
$5,544.84
|
| Rate for Payer: PacificSource Commercial |
$5,092.20
|
| Rate for Payer: PHCS PPO |
$5,544.84
|
| Rate for Payer: Three Rivers PPO |
$4,243.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,451.38
|
| Rate for Payer: United Healthcare Commercial |
$5,403.39
|
| Rate for Payer: United Healthcare Medicare |
$3,451.38
|
| Rate for Payer: WINHealth Partners Commercial |
$5,375.10
|
| Rate for Payer: Wise Provider Network Commercial |
$5,375.10
|
|
|
HC CATH INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH
|
Facility
|
OP
|
$5,658.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
4819356701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,063.81 |
| Max. Negotiated Rate |
$5,658.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,544.84
|
| Rate for Payer: Aetna of WY Medicare |
$3,734.28
|
| Rate for Payer: Altius Commercial |
$5,431.68
|
| Rate for Payer: Beech Street Commercial |
$5,544.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,488.26
|
| Rate for Payer: Cash Price |
$3,960.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,488.26
|
| Rate for Payer: Cigna of WY Commercial |
$5,544.84
|
| Rate for Payer: Entrust Commercial |
$5,375.10
|
| Rate for Payer: First Choice Health Commercial |
$5,375.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,375.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,225.06
|
| Rate for Payer: HealthUtah PPO |
$5,658.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,488.26
|
| Rate for Payer: Multiplan Medicare/VA |
$3,063.81
|
| Rate for Payer: One Health Plan of WY PPO |
$5,544.84
|
| Rate for Payer: PacificSource Commercial |
$5,092.20
|
| Rate for Payer: PHCS PPO |
$5,544.84
|
| Rate for Payer: Three Rivers PPO |
$4,243.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,225.06
|
| Rate for Payer: United Healthcare Commercial |
$5,403.39
|
| Rate for Payer: United Healthcare Medicare |
$3,225.06
|
| Rate for Payer: WINHealth Partners Commercial |
$5,544.84
|
| Rate for Payer: Wise Provider Network Commercial |
$5,375.10
|
|
|
HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,077.04 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,312.74
|
| Rate for Payer: Altius Commercial |
$1,909.44
|
| Rate for Payer: Beech Street Commercial |
$1,949.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,929.33
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: Entrust Commercial |
$1,889.55
|
| Rate for Payer: First Choice Health Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,133.73
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,077.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PHCS PPO |
$1,949.22
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,133.73
|
| Rate for Payer: United Healthcare Commercial |
$1,899.50
|
| Rate for Payer: United Healthcare Medicare |
$1,133.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,949.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1,889.55
|
|
|
HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,152.63 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,949.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,272.96
|
| Rate for Payer: Altius Commercial |
$1,909.44
|
| Rate for Payer: Beech Street Commercial |
$1,949.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,929.33
|
| Rate for Payer: Cash Price |
$1,392.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,929.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,949.22
|
| Rate for Payer: Entrust Commercial |
$1,889.55
|
| Rate for Payer: First Choice Health Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,889.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,213.29
|
| Rate for Payer: HealthUtah PPO |
$1,989.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,929.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,152.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,949.22
|
| Rate for Payer: PacificSource Commercial |
$1,790.10
|
| Rate for Payer: PHCS PPO |
$1,949.22
|
| Rate for Payer: Three Rivers PPO |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,213.29
|
| Rate for Payer: United Healthcare Commercial |
$1,899.50
|
| Rate for Payer: United Healthcare Medicare |
$1,213.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1,889.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,889.55
|
|
|
HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST
|
Facility
|
IP
|
$2,981.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
3527126002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,727.49 |
| Max. Negotiated Rate |
$2,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,921.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,907.84
|
| Rate for Payer: Altius Commercial |
$2,861.76
|
| Rate for Payer: Beech Street Commercial |
$2,921.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,891.57
|
| Rate for Payer: Cash Price |
$2,086.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,891.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,921.38
|
| Rate for Payer: Entrust Commercial |
$2,831.95
|
| Rate for Payer: First Choice Health Commercial |
$2,831.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,831.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,818.41
|
| Rate for Payer: HealthUtah PPO |
$2,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,891.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,727.49
|
| Rate for Payer: One Health Plan of WY PPO |
$2,921.38
|
| Rate for Payer: PacificSource Commercial |
$2,682.90
|
| Rate for Payer: PHCS PPO |
$2,921.38
|
| Rate for Payer: Three Rivers PPO |
$2,235.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,818.41
|
| Rate for Payer: United Healthcare Commercial |
$2,846.86
|
| Rate for Payer: United Healthcare Medicare |
$1,818.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,831.95
|
| Rate for Payer: Wise Provider Network Commercial |
$2,831.95
|
|
|
HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST
|
Facility
|
OP
|
$2,981.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
3527126002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,614.21 |
| Max. Negotiated Rate |
$2,981.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,921.38
|
| Rate for Payer: Aetna of WY Medicare |
$1,967.46
|
| Rate for Payer: Altius Commercial |
$2,861.76
|
| Rate for Payer: Beech Street Commercial |
$2,921.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,891.57
|
| Rate for Payer: Cash Price |
$2,086.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,891.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,921.38
|
| Rate for Payer: Entrust Commercial |
$2,831.95
|
| Rate for Payer: First Choice Health Commercial |
$2,831.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,831.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,699.17
|
| Rate for Payer: HealthUtah PPO |
$2,981.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,891.57
|
| Rate for Payer: Multiplan Medicare/VA |
$1,614.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,921.38
|
| Rate for Payer: PacificSource Commercial |
$2,682.90
|
| Rate for Payer: PHCS PPO |
$2,921.38
|
| Rate for Payer: Three Rivers PPO |
$2,235.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,699.17
|
| Rate for Payer: United Healthcare Commercial |
$2,846.86
|
| Rate for Payer: United Healthcare Medicare |
$1,699.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,921.38
|
| Rate for Payer: Wise Provider Network Commercial |
$2,831.95
|
|
|
HC C DIFF AMPLIFIED PROBE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$156.46 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$172.80
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.70
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$156.46
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$164.70
|
| Rate for Payer: United Healthcare Commercial |
$257.85
|
| Rate for Payer: United Healthcare Medicare |
$164.70
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC C DIFF AMPLIFIED PROBE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.90
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$146.20
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$153.90
|
| Rate for Payer: United Healthcare Commercial |
$257.85
|
| Rate for Payer: United Healthcare Medicare |
$153.90
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC C DIFF AMPLIFIED PROBE - TOXIN A & B GENE
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC C DIFF AMPLIFIED PROBE - TOXIN A & B GENE
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$64.64
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.97
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.61
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$58.53
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.61
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$61.61
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.69 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$66.66
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.97
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.57
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$54.69
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$57.57
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$57.57
|
| Rate for Payer: WINHealth Partners Commercial |
$98.98
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,787.40 |
| Max. Negotiated Rate |
$4,810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,713.80
|
| Rate for Payer: Aetna of WY Medicare |
$3,078.40
|
| Rate for Payer: Altius Commercial |
$4,617.60
|
| Rate for Payer: Beech Street Commercial |
$4,713.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,665.70
|
| Rate for Payer: Cash Price |
$3,367.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,665.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,713.80
|
| Rate for Payer: Entrust Commercial |
$4,569.50
|
| Rate for Payer: First Choice Health Commercial |
$4,569.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,569.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,934.10
|
| Rate for Payer: HealthUtah PPO |
$4,810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,665.70
|
| Rate for Payer: Multiplan Medicare/VA |
$2,787.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,713.80
|
| Rate for Payer: PacificSource Commercial |
$4,329.00
|
| Rate for Payer: PHCS PPO |
$4,713.80
|
| Rate for Payer: Three Rivers PPO |
$3,607.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,934.10
|
| Rate for Payer: United Healthcare Commercial |
$4,593.55
|
| Rate for Payer: United Healthcare Medicare |
$2,934.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,569.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,569.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,604.62 |
| Max. Negotiated Rate |
$4,810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,713.80
|
| Rate for Payer: Aetna of WY Medicare |
$3,174.60
|
| Rate for Payer: Altius Commercial |
$4,617.60
|
| Rate for Payer: Beech Street Commercial |
$4,713.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,665.70
|
| Rate for Payer: Cash Price |
$3,367.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,665.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,713.80
|
| Rate for Payer: Entrust Commercial |
$4,569.50
|
| Rate for Payer: First Choice Health Commercial |
$4,569.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,569.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,741.70
|
| Rate for Payer: HealthUtah PPO |
$4,810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,665.70
|
| Rate for Payer: Multiplan Medicare/VA |
$2,604.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4,713.80
|
| Rate for Payer: PacificSource Commercial |
$4,329.00
|
| Rate for Payer: PHCS PPO |
$4,713.80
|
| Rate for Payer: Three Rivers PPO |
$3,607.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,741.70
|
| Rate for Payer: United Healthcare Commercial |
$4,593.55
|
| Rate for Payer: United Healthcare Medicare |
$2,741.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,713.80
|
| Rate for Payer: Wise Provider Network Commercial |
$4,569.50
|
|
