|
HC MOD SED PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
3709915601
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC MOD SED SAME PHYS <5 YRS
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
3709915101
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$168.30
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Multiplan Medicare/VA |
$140.50
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$147.90
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Medicare |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: WINHealth Partners Commercial |
$249.90
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
|
|
HC MOD SED SAME PHYS <5 YRS
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
3709915101
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.90
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$244.80
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Altius Commercial |
$244.80
|
| Rate for Payer: Beech Street Commercial |
$249.90
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Cigna of WY Commercial |
$249.90
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: Entrust Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$242.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$255.00
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$159.88
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: One Health Plan of WY PPO |
$249.90
|
| Rate for Payer: PacificSource Commercial |
$229.50
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: PHCS PPO |
$249.90
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: Three Rivers PPO |
$191.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.30
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: United Healthcare Medicare |
$168.30
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: WINHealth Partners Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$242.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
3709915301
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,151.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,128.00
|
| Rate for Payer: Altius Commercial |
$1,128.00
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Beech Street Commercial |
$1,151.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$964.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$822.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,139.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,151.50
|
| Rate for Payer: Entrust Commercial |
$1,116.25
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$1,116.25
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,116.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$775.50
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: HealthUtah PPO |
$1,175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,139.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: Multiplan Medicare/VA |
$736.72
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,151.50
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PacificSource Commercial |
$1,057.50
|
| Rate for Payer: PHCS PPO |
$1,151.50
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$881.25
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: TriWest Veterans Administration |
$775.50
|
| Rate for Payer: United Healthcare Commercial |
$1,022.25
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: United Healthcare Medicare |
$775.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,116.25
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,116.25
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
3709915301
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,151.50
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| Rate for Payer: Aetna of WY Medicare |
$775.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,128.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Altius Commercial |
$1,128.00
|
| Rate for Payer: Beech Street Commercial |
$1,151.50
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$964.68
|
| Rate for Payer: Cash Price |
$822.50
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,139.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,151.50
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: Entrust Commercial |
$1,116.25
|
| Rate for Payer: First Choice Health Commercial |
$1,116.25
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,116.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.50
|
| Rate for Payer: HealthUtah PPO |
$1,175.00
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,139.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| Rate for Payer: Multiplan Medicare/VA |
$647.42
|
| Rate for Payer: One Health Plan of WY PPO |
$1,151.50
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PacificSource Commercial |
$1,057.50
|
| Rate for Payer: PHCS PPO |
$1,151.50
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$881.25
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.62
|
| Rate for Payer: TriWest Veterans Administration |
$681.50
|
| Rate for Payer: United Healthcare Commercial |
$1,022.25
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: United Healthcare Medicare |
$681.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,151.50
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$1,116.25
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
3709915201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$739.86 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,156.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,132.80
|
| Rate for Payer: Altius Commercial |
$1,132.80
|
| Rate for Payer: Beech Street Commercial |
$1,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$968.78
|
| Rate for Payer: Cash Price |
$826.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,144.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,156.40
|
| Rate for Payer: Entrust Commercial |
$1,121.00
|
| Rate for Payer: First Choice Health Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$778.80
|
| Rate for Payer: HealthUtah PPO |
$1,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,144.60
|
| Rate for Payer: Multiplan Medicare/VA |
$739.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,156.40
|
| Rate for Payer: PacificSource Commercial |
$1,062.00
|
| Rate for Payer: PHCS PPO |
$1,156.40
|
| Rate for Payer: Three Rivers PPO |
$885.00
|
| Rate for Payer: TriWest Veterans Administration |
$778.80
|
| Rate for Payer: United Healthcare Commercial |
$1,026.60
|
| Rate for Payer: United Healthcare Medicare |
$778.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,121.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,121.00
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
3709915201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$650.18 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,156.40
|
| Rate for Payer: Aetna of WY Medicare |
$778.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,132.80
|
| Rate for Payer: Altius Commercial |
$1,132.80
|
| Rate for Payer: Beech Street Commercial |
$1,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$968.78
|
| Rate for Payer: Cash Price |
$826.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,144.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,156.40
|
| Rate for Payer: Entrust Commercial |
$1,121.00
|
| Rate for Payer: First Choice Health Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,121.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$684.40
|
| Rate for Payer: HealthUtah PPO |
$1,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,144.60
|
| Rate for Payer: Multiplan Medicare/VA |
$650.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,156.40
|
| Rate for Payer: PacificSource Commercial |
$1,062.00
|
| Rate for Payer: PHCS PPO |
$1,156.40
|
| Rate for Payer: Three Rivers PPO |
$885.00
|
| Rate for Payer: TriWest Veterans Administration |
$684.40
|
| Rate for Payer: United Healthcare Commercial |
$1,026.60
|
| Rate for Payer: United Healthcare Medicare |
$684.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,121.00
|
|
|
HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86362
|
| Hospital Charge Code |
3028636201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86362
|
| Hospital Charge Code |
3028636201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC MOLECULAR CYTOGENETICS 10 -30 CELLS
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
3118827301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC MOLECULAR CYTOGENETICS 10 -30 CELLS
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 88273
|
| Hospital Charge Code |
3118827301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC MOLECULAR CYTOGENETICS DNA PROBE EACH
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
3118827101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MOLECULAR CYTOGENETICS DNA PROBE EACH
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
3118827101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
3008140102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,257.20 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,528.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,456.00
|
| Rate for Payer: Altius Commercial |
$3,456.00
|
| Rate for Payer: Beech Street Commercial |
$3,528.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,492.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,528.00
|
| Rate for Payer: Entrust Commercial |
$3,420.00
|
| Rate for Payer: First Choice Health Commercial |
$3,420.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,420.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,376.00
|
| Rate for Payer: HealthUtah PPO |
$3,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,492.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,257.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3,528.00
|
| Rate for Payer: PacificSource Commercial |
$3,240.00
|
| Rate for Payer: PHCS PPO |
$3,528.00
|
| Rate for Payer: Three Rivers PPO |
$2,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,376.00
|
| Rate for Payer: United Healthcare Commercial |
$3,132.00
|
| Rate for Payer: United Healthcare Medicare |
$2,376.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,420.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,420.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
3008140102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,983.60 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,528.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,376.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,456.00
|
| Rate for Payer: Altius Commercial |
$3,456.00
|
| Rate for Payer: Beech Street Commercial |
$3,528.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,955.60
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,492.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,528.00
|
| Rate for Payer: Entrust Commercial |
$3,420.00
|
| Rate for Payer: First Choice Health Commercial |
$3,420.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,420.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,088.00
|
| Rate for Payer: HealthUtah PPO |
$3,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,492.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,983.60
|
| Rate for Payer: One Health Plan of WY PPO |
$3,528.00
|
| Rate for Payer: PacificSource Commercial |
$3,240.00
|
| Rate for Payer: PHCS PPO |
$3,528.00
|
| Rate for Payer: Three Rivers PPO |
$2,700.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,088.00
|
| Rate for Payer: United Healthcare Commercial |
$3,132.00
|
| Rate for Payer: United Healthcare Medicare |
$2,088.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,528.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,420.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - PLASMINOGEN ACT INHIN 1
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
3108140001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Medicare |
$376.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.60
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$314.07
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$330.60
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$330.60
|
| Rate for Payer: WINHealth Partners Commercial |
$558.60
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - PLASMINOGEN ACT INHIN 1
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 81400
|
| Hospital Charge Code |
3108140001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.20
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$357.39
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$376.20
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$376.20
|
| Rate for Payer: WINHealth Partners Commercial |
$541.50
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - SPINAL MUSCULAR ATROPHY DNA
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
3008140101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$789.39 |
| Max. Negotiated Rate |
$1,259.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,233.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,208.64
|
| Rate for Payer: Altius Commercial |
$1,208.64
|
| Rate for Payer: Beech Street Commercial |
$1,233.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,033.64
|
| Rate for Payer: Cash Price |
$881.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,221.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,233.82
|
| Rate for Payer: Entrust Commercial |
$1,196.05
|
| Rate for Payer: First Choice Health Commercial |
$1,196.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,196.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$830.94
|
| Rate for Payer: HealthUtah PPO |
$1,259.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,221.23
|
| Rate for Payer: Multiplan Medicare/VA |
$789.39
|
| Rate for Payer: One Health Plan of WY PPO |
$1,233.82
|
| Rate for Payer: PacificSource Commercial |
$1,133.10
|
| Rate for Payer: PHCS PPO |
$1,233.82
|
| Rate for Payer: Three Rivers PPO |
$944.25
|
| Rate for Payer: TriWest Veterans Administration |
$830.94
|
| Rate for Payer: United Healthcare Commercial |
$1,095.33
|
| Rate for Payer: United Healthcare Medicare |
$830.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,196.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,196.05
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - SPINAL MUSCULAR ATROPHY DNA
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
3008140101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$693.71 |
| Max. Negotiated Rate |
$1,259.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,233.82
|
| Rate for Payer: Aetna of WY Medicare |
$830.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,208.64
|
| Rate for Payer: Altius Commercial |
$1,208.64
|
| Rate for Payer: Beech Street Commercial |
$1,233.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,033.64
|
| Rate for Payer: Cash Price |
$881.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,221.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,233.82
|
| Rate for Payer: Entrust Commercial |
$1,196.05
|
| Rate for Payer: First Choice Health Commercial |
$1,196.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,196.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$730.22
|
| Rate for Payer: HealthUtah PPO |
$1,259.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,221.23
|
| Rate for Payer: Multiplan Medicare/VA |
$693.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,233.82
|
| Rate for Payer: PacificSource Commercial |
$1,133.10
|
| Rate for Payer: PHCS PPO |
$1,233.82
|
| Rate for Payer: Three Rivers PPO |
$944.25
|
| Rate for Payer: TriWest Veterans Administration |
$730.22
|
| Rate for Payer: United Healthcare Commercial |
$1,095.33
|
| Rate for Payer: United Healthcare Medicare |
$730.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,233.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,196.05
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - STK11 GENE MUTATION
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
3108140402
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,377.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,650.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,377.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,450.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 - STK11 GENE MUTATION
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 81404
|
| Hospital Charge Code |
3108140402
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.00
|
| Rate for Payer: Altius Commercial |
$2,400.00
|
| Rate for Payer: Beech Street Commercial |
$2,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,052.50
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.00
|
| Rate for Payer: Entrust Commercial |
$2,375.00
|
| Rate for Payer: First Choice Health Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.00
|
| Rate for Payer: HealthUtah PPO |
$2,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,567.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.00
|
| Rate for Payer: PacificSource Commercial |
$2,250.00
|
| Rate for Payer: PHCS PPO |
$2,450.00
|
| Rate for Payer: Three Rivers PPO |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.00
|
| Rate for Payer: United Healthcare Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Medicare |
$1,650.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,375.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
3108140301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$661.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,176.00
|
| Rate for Payer: Aetna of WY Medicare |
$792.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,152.00
|
| Rate for Payer: Altius Commercial |
$1,152.00
|
| Rate for Payer: Beech Street Commercial |
$1,176.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$985.20
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,164.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,176.00
|
| Rate for Payer: Entrust Commercial |
$1,140.00
|
| Rate for Payer: First Choice Health Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.00
|
| Rate for Payer: HealthUtah PPO |
$1,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,164.00
|
| Rate for Payer: Multiplan Medicare/VA |
$661.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,176.00
|
| Rate for Payer: PacificSource Commercial |
$1,080.00
|
| Rate for Payer: PHCS PPO |
$1,176.00
|
| Rate for Payer: Three Rivers PPO |
$900.00
|
| Rate for Payer: TriWest Veterans Administration |
$696.00
|
| Rate for Payer: United Healthcare Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare Medicare |
$696.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,140.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
3108140301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,176.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,152.00
|
| Rate for Payer: Altius Commercial |
$1,152.00
|
| Rate for Payer: Beech Street Commercial |
$1,176.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$985.20
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,164.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,176.00
|
| Rate for Payer: Entrust Commercial |
$1,140.00
|
| Rate for Payer: First Choice Health Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$792.00
|
| Rate for Payer: HealthUtah PPO |
$1,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,164.00
|
| Rate for Payer: Multiplan Medicare/VA |
$752.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,176.00
|
| Rate for Payer: PacificSource Commercial |
$1,080.00
|
| Rate for Payer: PHCS PPO |
$1,176.00
|
| Rate for Payer: Three Rivers PPO |
$900.00
|
| Rate for Payer: TriWest Veterans Administration |
$792.00
|
| Rate for Payer: United Healthcare Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare Medicare |
$792.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,140.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,140.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 - MEN2 RET GENE MUTATION STUDY
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
3108140501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,487.70 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,782.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,592.00
|
| Rate for Payer: Altius Commercial |
$2,592.00
|
| Rate for Payer: Beech Street Commercial |
$2,646.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,216.70
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: Entrust Commercial |
$2,565.00
|
| Rate for Payer: First Choice Health Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,566.00
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,487.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,646.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,566.00
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$1,566.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,565.00
|
|
|
HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 - MEN2 RET GENE MUTATION STUDY
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 81405
|
| Hospital Charge Code |
3108140501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,692.90 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,646.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,592.00
|
| Rate for Payer: Altius Commercial |
$2,592.00
|
| Rate for Payer: Beech Street Commercial |
$2,646.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,216.70
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,619.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,646.00
|
| Rate for Payer: Entrust Commercial |
$2,565.00
|
| Rate for Payer: First Choice Health Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,565.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,782.00
|
| Rate for Payer: HealthUtah PPO |
$2,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,619.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,692.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,646.00
|
| Rate for Payer: PacificSource Commercial |
$2,430.00
|
| Rate for Payer: PHCS PPO |
$2,646.00
|
| Rate for Payer: Three Rivers PPO |
$2,025.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,782.00
|
| Rate for Payer: United Healthcare Commercial |
$2,349.00
|
| Rate for Payer: United Healthcare Medicare |
$1,782.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,565.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,565.00
|
|
