|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HAND RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321804
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,248.02 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,219.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,494.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,174.40
|
| Rate for Payer: Altius Commercial |
$2,174.40
|
| Rate for Payer: Beech Street Commercial |
$2,219.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,859.56
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,197.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,219.70
|
| Rate for Payer: Entrust Commercial |
$2,151.75
|
| Rate for Payer: First Choice Health Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,313.70
|
| Rate for Payer: HealthUtah PPO |
$2,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,197.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,248.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,219.70
|
| Rate for Payer: PacificSource Commercial |
$2,038.50
|
| Rate for Payer: PHCS PPO |
$2,219.70
|
| Rate for Payer: Three Rivers PPO |
$1,698.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,313.70
|
| Rate for Payer: United Healthcare Commercial |
$1,970.55
|
| Rate for Payer: United Healthcare Medicare |
$1,313.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,219.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,151.75
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HAND RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321804
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,420.16 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,219.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,174.40
|
| Rate for Payer: Altius Commercial |
$2,174.40
|
| Rate for Payer: Beech Street Commercial |
$2,219.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,859.56
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,197.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,219.70
|
| Rate for Payer: Entrust Commercial |
$2,151.75
|
| Rate for Payer: First Choice Health Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,494.90
|
| Rate for Payer: HealthUtah PPO |
$2,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,197.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,420.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,219.70
|
| Rate for Payer: PacificSource Commercial |
$2,038.50
|
| Rate for Payer: PHCS PPO |
$2,219.70
|
| Rate for Payer: Three Rivers PPO |
$1,698.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,494.90
|
| Rate for Payer: United Healthcare Commercial |
$1,970.55
|
| Rate for Payer: United Healthcare Medicare |
$1,494.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,151.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,151.75
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321806
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,420.16 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,219.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,174.40
|
| Rate for Payer: Altius Commercial |
$2,174.40
|
| Rate for Payer: Beech Street Commercial |
$2,219.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,859.56
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,197.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,219.70
|
| Rate for Payer: Entrust Commercial |
$2,151.75
|
| Rate for Payer: First Choice Health Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,494.90
|
| Rate for Payer: HealthUtah PPO |
$2,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,197.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,420.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,219.70
|
| Rate for Payer: PacificSource Commercial |
$2,038.50
|
| Rate for Payer: PHCS PPO |
$2,219.70
|
| Rate for Payer: Three Rivers PPO |
$1,698.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,494.90
|
| Rate for Payer: United Healthcare Commercial |
$1,970.55
|
| Rate for Payer: United Healthcare Medicare |
$1,494.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,151.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,151.75
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HUMERUS RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321806
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,248.02 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,219.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,494.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,174.40
|
| Rate for Payer: Altius Commercial |
$2,174.40
|
| Rate for Payer: Beech Street Commercial |
$2,219.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,859.56
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,197.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,219.70
|
| Rate for Payer: Entrust Commercial |
$2,151.75
|
| Rate for Payer: First Choice Health Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,151.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,313.70
|
| Rate for Payer: HealthUtah PPO |
$2,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,197.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,248.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,219.70
|
| Rate for Payer: PacificSource Commercial |
$2,038.50
|
| Rate for Payer: PHCS PPO |
$2,219.70
|
| Rate for Payer: Three Rivers PPO |
$1,698.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,313.70
|
| Rate for Payer: United Healthcare Commercial |
$1,970.55
|
| Rate for Payer: United Healthcare Medicare |
$1,313.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,219.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,151.75
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA LT WO IV CONTRAST
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321801
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA LT WO IV CONTRAST
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321801
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA RT WO IV CONTRAST
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR RADIUS ULNA RT WO IV CONTRAST
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRSA, DNA, AMP PROBE - MR STAPH DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
3068764101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.77 |
| 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 Auto/Workers Compensation |
$259.20
|
| 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 |
$221.67
|
| 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 |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| 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 |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC MRSA, DNA, AMP PROBE - MR STAPH DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
3068764101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| 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 |
$221.67
|
| 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 |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| 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 |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 81297
|
| Hospital Charge Code |
3108129701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,046.90 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,254.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,046.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,102.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,862.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 81297
|
| Hospital Charge Code |
3108129701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,824.00
|
| Rate for Payer: Altius Commercial |
$1,824.00
|
| Rate for Payer: Beech Street Commercial |
$1,862.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,330.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.00
|
| Rate for Payer: Entrust Commercial |
$1,805.00
|
| Rate for Payer: First Choice Health Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,254.00
|
| Rate for Payer: HealthUtah PPO |
$1,900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,191.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.00
|
| Rate for Payer: PacificSource Commercial |
$1,710.00
|
| Rate for Payer: PHCS PPO |
$1,862.00
|
| Rate for Payer: Three Rivers PPO |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,254.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare |
$1,254.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.00
|
|
|
HC MSH2 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 81295
|
| Hospital Charge Code |
3108129501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,873.40 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,332.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,244.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,264.00
|
| Rate for Payer: Altius Commercial |
$3,264.00
|
| Rate for Payer: Beech Street Commercial |
$3,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,791.40
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,298.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,332.00
|
| Rate for Payer: Entrust Commercial |
$3,230.00
|
| Rate for Payer: First Choice Health Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,972.00
|
| Rate for Payer: HealthUtah PPO |
$3,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,298.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,873.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,332.00
|
| Rate for Payer: PacificSource Commercial |
$3,060.00
|
| Rate for Payer: PHCS PPO |
$3,332.00
|
| Rate for Payer: Three Rivers PPO |
$2,550.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,972.00
|
| Rate for Payer: United Healthcare Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare Medicare |
$1,972.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,332.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,230.00
|
|
|
HC MSH2 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 81295
|
| Hospital Charge Code |
3108129501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,131.80 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,332.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,264.00
|
| Rate for Payer: Altius Commercial |
$3,264.00
|
| Rate for Payer: Beech Street Commercial |
$3,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,791.40
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,298.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,332.00
|
| Rate for Payer: Entrust Commercial |
$3,230.00
|
| Rate for Payer: First Choice Health Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,230.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,244.00
|
| Rate for Payer: HealthUtah PPO |
$3,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,298.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,131.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,332.00
|
| Rate for Payer: PacificSource Commercial |
$3,060.00
|
| Rate for Payer: PHCS PPO |
$3,332.00
|
| Rate for Payer: Three Rivers PPO |
$2,550.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare Medicare |
$2,244.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,230.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,230.00
|
|
|
HC MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 81300
|
| Hospital Charge Code |
3108130001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,168.12 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,077.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,399.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,035.20
|
| Rate for Payer: Altius Commercial |
$2,035.20
|
| Rate for Payer: Beech Street Commercial |
$2,077.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,740.52
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,056.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,077.60
|
| Rate for Payer: Entrust Commercial |
$2,014.00
|
| Rate for Payer: First Choice Health Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,229.60
|
| Rate for Payer: HealthUtah PPO |
$2,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,056.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,168.12
|
| Rate for Payer: One Health Plan of WY PPO |
$2,077.60
|
| Rate for Payer: PacificSource Commercial |
$1,908.00
|
| Rate for Payer: PHCS PPO |
$2,077.60
|
| Rate for Payer: Three Rivers PPO |
$1,590.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,229.60
|
| Rate for Payer: United Healthcare Commercial |
$1,844.40
|
| Rate for Payer: United Healthcare Medicare |
$1,229.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,077.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,014.00
|
|
|
HC MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 81300
|
| Hospital Charge Code |
3108130001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,329.24 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,077.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,035.20
|
| Rate for Payer: Altius Commercial |
$2,035.20
|
| Rate for Payer: Beech Street Commercial |
$2,077.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,740.52
|
| Rate for Payer: Cash Price |
$1,484.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,056.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,077.60
|
| Rate for Payer: Entrust Commercial |
$2,014.00
|
| Rate for Payer: First Choice Health Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,014.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,399.20
|
| Rate for Payer: HealthUtah PPO |
$2,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,056.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,329.24
|
| Rate for Payer: One Health Plan of WY PPO |
$2,077.60
|
| Rate for Payer: PacificSource Commercial |
$1,908.00
|
| Rate for Payer: PHCS PPO |
$2,077.60
|
| Rate for Payer: Three Rivers PPO |
$1,590.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,399.20
|
| Rate for Payer: United Healthcare Commercial |
$1,844.40
|
| Rate for Payer: United Healthcare Medicare |
$1,399.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,014.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,014.00
|
|
|
HC MSH6 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
OP
|
$5,715.00
|
|
|
Service Code
|
HCPCS 81298
|
| Hospital Charge Code |
3108129801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,148.96 |
| Max. Negotiated Rate |
$5,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,600.70
|
| Rate for Payer: Aetna of WY Medicare |
$3,771.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,486.40
|
| Rate for Payer: Altius Commercial |
$5,486.40
|
| Rate for Payer: Beech Street Commercial |
$5,600.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,692.02
|
| Rate for Payer: Cash Price |
$4,000.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,543.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,600.70
|
| Rate for Payer: Entrust Commercial |
$5,429.25
|
| Rate for Payer: First Choice Health Commercial |
$5,429.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,429.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,314.70
|
| Rate for Payer: HealthUtah PPO |
$5,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,543.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$5,600.70
|
| Rate for Payer: PacificSource Commercial |
$5,143.50
|
| Rate for Payer: PHCS PPO |
$5,600.70
|
| Rate for Payer: Three Rivers PPO |
$4,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,314.70
|
| Rate for Payer: United Healthcare Commercial |
$4,972.05
|
| Rate for Payer: United Healthcare Medicare |
$3,314.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,600.70
|
| Rate for Payer: Wise Provider Network Commercial |
$5,429.25
|
|
|
HC MSH6 GENE ANALYSIS FULL SEQUENCE
|
Facility
|
IP
|
$5,715.00
|
|
|
Service Code
|
HCPCS 81298
|
| Hospital Charge Code |
3108129801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,583.30 |
| Max. Negotiated Rate |
$5,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,600.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,486.40
|
| Rate for Payer: Altius Commercial |
$5,486.40
|
| Rate for Payer: Beech Street Commercial |
$5,600.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,692.02
|
| Rate for Payer: Cash Price |
$4,000.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,543.55
|
| Rate for Payer: Cigna of WY Commercial |
$5,600.70
|
| Rate for Payer: Entrust Commercial |
$5,429.25
|
| Rate for Payer: First Choice Health Commercial |
$5,429.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,429.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,771.90
|
| Rate for Payer: HealthUtah PPO |
$5,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,543.55
|
| Rate for Payer: Multiplan Medicare/VA |
$3,583.30
|
| Rate for Payer: One Health Plan of WY PPO |
$5,600.70
|
| Rate for Payer: PacificSource Commercial |
$5,143.50
|
| Rate for Payer: PHCS PPO |
$5,600.70
|
| Rate for Payer: Three Rivers PPO |
$4,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,771.90
|
| Rate for Payer: United Healthcare Commercial |
$4,972.05
|
| Rate for Payer: United Healthcare Medicare |
$3,771.90
|
| Rate for Payer: WINHealth Partners Commercial |
$5,429.25
|
| Rate for Payer: Wise Provider Network Commercial |
$5,429.25
|
|
|
HC MTHFR METHYLENETRAHYDROFOLATE GENE ANAL - METHYLENETRAHYDROFOLATE
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
3108129101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC MTHFR METHYLENETRAHYDROFOLATE GENE ANAL - METHYLENETRAHYDROFOLATE
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
3108129101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
3068755601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC M.TUBERCULO, DNA, AMP PROBE - M. TUBERCULOSIS DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
3068755601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC MUCOPOLYSACCHARIDES - MUCOPOLYSACCHARIDES SCREEN
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 83864
|
| Hospital Charge Code |
3018386401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
