HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB
|
Facility
|
OP
|
$340.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
3028623501
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$187.34 |
Max. Negotiated Rate |
$340.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
Rate for Payer: Aetna of WY Medicare |
$224.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
Rate for Payer: Altius Commercial |
$326.40
|
Rate for Payer: Beech Street Commercial |
$333.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
Rate for Payer: Cash Price |
$238.00
|
Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
Rate for Payer: Cigna of WY Commercial |
$333.20
|
Rate for Payer: Entrust Commercial |
$323.00
|
Rate for Payer: First Choice Health Commercial |
$323.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
Rate for Payer: HealthUtah PPO |
$340.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
Rate for Payer: Multiplan Medicare/VA |
$187.34
|
Rate for Payer: One Health Plan of WY PPO |
$333.20
|
Rate for Payer: PacificSource Commercial |
$306.00
|
Rate for Payer: PHCS PPO |
$333.20
|
Rate for Payer: Three Rivers PPO |
$255.00
|
Rate for Payer: TriWest Veterans Administration |
$197.20
|
Rate for Payer: United Healthcare Commercial |
$295.80
|
Rate for Payer: United Healthcare Medicare |
$197.20
|
Rate for Payer: WINHealth Partners Commercial |
$333.20
|
Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB
|
Facility
|
IP
|
$340.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
3028623501
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$213.18 |
Max. Negotiated Rate |
$340.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
Rate for Payer: Altius Commercial |
$326.40
|
Rate for Payer: Beech Street Commercial |
$333.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
Rate for Payer: Cash Price |
$238.00
|
Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
Rate for Payer: Cigna of WY Commercial |
$333.20
|
Rate for Payer: Entrust Commercial |
$323.00
|
Rate for Payer: First Choice Health Commercial |
$323.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
Rate for Payer: HealthUtah PPO |
$340.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
Rate for Payer: Multiplan Medicare/VA |
$213.18
|
Rate for Payer: One Health Plan of WY PPO |
$333.20
|
Rate for Payer: PacificSource Commercial |
$306.00
|
Rate for Payer: PHCS PPO |
$333.20
|
Rate for Payer: Three Rivers PPO |
$255.00
|
Rate for Payer: TriWest Veterans Administration |
$224.40
|
Rate for Payer: United Healthcare Commercial |
$295.80
|
Rate for Payer: United Healthcare Medicare |
$224.40
|
Rate for Payer: WINHealth Partners Commercial |
$323.00
|
Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-B EXT NUC AB
|
Facility
|
OP
|
$275.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
3028623502
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$151.52 |
Max. Negotiated Rate |
$275.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
Rate for Payer: Aetna of WY Medicare |
$181.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
Rate for Payer: Altius Commercial |
$264.00
|
Rate for Payer: Beech Street Commercial |
$269.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
Rate for Payer: Cigna of WY Commercial |
$269.50
|
Rate for Payer: Entrust Commercial |
$261.25
|
Rate for Payer: First Choice Health Commercial |
$261.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.50
|
Rate for Payer: HealthUtah PPO |
$275.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
Rate for Payer: Multiplan Medicare/VA |
$151.52
|
Rate for Payer: One Health Plan of WY PPO |
$269.50
|
Rate for Payer: PacificSource Commercial |
$247.50
|
Rate for Payer: PHCS PPO |
$269.50
|
Rate for Payer: Three Rivers PPO |
$206.25
|
Rate for Payer: TriWest Veterans Administration |
$159.50
|
Rate for Payer: United Healthcare Commercial |
$239.25
|
Rate for Payer: United Healthcare Medicare |
$159.50
|
Rate for Payer: WINHealth Partners Commercial |
$269.50
|
Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-B EXT NUC AB
|
Facility
|
IP
|
$275.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
3028623502
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$172.42 |
Max. Negotiated Rate |
$275.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$264.00
|
Rate for Payer: Altius Commercial |
$264.00
|
Rate for Payer: Beech Street Commercial |
$269.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.78
|
Rate for Payer: Cash Price |
$192.50
|
Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
Rate for Payer: Cigna of WY Commercial |
$269.50
|
Rate for Payer: Entrust Commercial |
$261.25
|
Rate for Payer: First Choice Health Commercial |
$261.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.50
|
Rate for Payer: HealthUtah PPO |
$275.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
Rate for Payer: Multiplan Medicare/VA |
$172.42
|
Rate for Payer: One Health Plan of WY PPO |
$269.50
|
Rate for Payer: PacificSource Commercial |
$247.50
|
Rate for Payer: PHCS PPO |
$269.50
|
Rate for Payer: Three Rivers PPO |
$206.25
|
Rate for Payer: TriWest Veterans Administration |
$181.50
|
Rate for Payer: United Healthcare Commercial |
$239.25
|
Rate for Payer: United Healthcare Medicare |
$181.50
|
Rate for Payer: WINHealth Partners Commercial |
$261.25
|
Rate for Payer: Wise Provider Network Commercial |
$261.25
|
|
HC NURSERY 1 ROOM DAILY
|
Facility
|
IP
|
$1,510.00
|
|
Hospital Charge Code |
1710000001
|
Hospital Revenue Code
|
171
|
Min. Negotiated Rate |
$946.77 |
Max. Negotiated Rate |
$1,510.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,479.80
|
Rate for Payer: Aetna of WY Medicare |
$966.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,449.60
|
Rate for Payer: Altius Commercial |
$1,449.60
|
Rate for Payer: Beech Street Commercial |
$1,479.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,239.71
|
Rate for Payer: Cash Price |
$1,057.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,464.70
|
Rate for Payer: Cigna of WY Commercial |
$1,479.80
|
Rate for Payer: Entrust Commercial |
$1,434.50
|
Rate for Payer: First Choice Health Commercial |
$1,434.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,434.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$996.60
|
Rate for Payer: HealthUtah PPO |
$1,510.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,464.70
|
Rate for Payer: Multiplan Medicare/VA |
$946.77
|
Rate for Payer: One Health Plan of WY PPO |
$1,479.80
|
Rate for Payer: PacificSource Commercial |
$1,359.00
|
Rate for Payer: PHCS PPO |
$1,479.80
|
Rate for Payer: Three Rivers PPO |
$1,132.50
|
Rate for Payer: TriWest Veterans Administration |
$996.60
|
Rate for Payer: United Healthcare Commercial |
$1,313.70
|
Rate for Payer: United Healthcare Medicare |
$996.60
|
Rate for Payer: WINHealth Partners Commercial |
$1,434.50
|
Rate for Payer: Wise Provider Network Commercial |
$1,434.50
|
|
HC NURSERY 2 ROOM DAILY
|
Facility
|
IP
|
$2,275.00
|
|
Hospital Charge Code |
1720000001
|
Hospital Revenue Code
|
172
|
Min. Negotiated Rate |
$1,426.42 |
Max. Negotiated Rate |
$2,275.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,229.50
|
Rate for Payer: Aetna of WY Medicare |
$1,456.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$2,184.00
|
Rate for Payer: Altius Commercial |
$2,184.00
|
Rate for Payer: Beech Street Commercial |
$2,229.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,867.78
|
Rate for Payer: Cash Price |
$1,592.50
|
Rate for Payer: ChoiceCare Network Commercial |
$2,206.75
|
Rate for Payer: Cigna of WY Commercial |
$2,229.50
|
Rate for Payer: Entrust Commercial |
$2,161.25
|
Rate for Payer: First Choice Health Commercial |
$2,161.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,161.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,501.50
|
Rate for Payer: HealthUtah PPO |
$2,275.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,206.75
|
Rate for Payer: Multiplan Medicare/VA |
$1,426.42
|
Rate for Payer: One Health Plan of WY PPO |
$2,229.50
|
Rate for Payer: PacificSource Commercial |
$2,047.50
|
Rate for Payer: PHCS PPO |
$2,229.50
|
Rate for Payer: Three Rivers PPO |
$1,706.25
|
Rate for Payer: TriWest Veterans Administration |
$1,501.50
|
Rate for Payer: United Healthcare Commercial |
$1,979.25
|
Rate for Payer: United Healthcare Medicare |
$1,501.50
|
Rate for Payer: WINHealth Partners Commercial |
$2,161.25
|
Rate for Payer: Wise Provider Network Commercial |
$2,161.25
|
|
HC NURSERY 3 ROOM DAILY
|
Facility
|
IP
|
$2,600.00
|
|
Hospital Charge Code |
1730000001
|
Hospital Revenue Code
|
173
|
Min. Negotiated Rate |
$1,630.20 |
Max. Negotiated Rate |
$2,600.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
Rate for Payer: Aetna of WY Medicare |
$1,664.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$2,496.00
|
Rate for Payer: Altius Commercial |
$2,496.00
|
Rate for Payer: Beech Street Commercial |
$2,548.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,134.60
|
Rate for Payer: Cash Price |
$1,820.00
|
Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
Rate for Payer: Entrust Commercial |
$2,470.00
|
Rate for Payer: First Choice Health Commercial |
$2,470.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,716.00
|
Rate for Payer: HealthUtah PPO |
$2,600.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
Rate for Payer: Multiplan Medicare/VA |
$1,630.20
|
Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
Rate for Payer: PacificSource Commercial |
$2,340.00
|
Rate for Payer: PHCS PPO |
$2,548.00
|
Rate for Payer: Three Rivers PPO |
$1,950.00
|
Rate for Payer: TriWest Veterans Administration |
$1,716.00
|
Rate for Payer: United Healthcare Commercial |
$2,262.00
|
Rate for Payer: United Healthcare Medicare |
$1,716.00
|
Rate for Payer: WINHealth Partners Commercial |
$2,470.00
|
Rate for Payer: Wise Provider Network Commercial |
$2,470.00
|
|
HC OB LABOR
|
Facility
|
OP
|
$1,410.00
|
|
Hospital Charge Code |
7210000005
|
Hospital Revenue Code
|
721
|
Min. Negotiated Rate |
$776.91 |
Max. Negotiated Rate |
$1,410.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,381.80
|
Rate for Payer: Aetna of WY Medicare |
$930.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,353.60
|
Rate for Payer: Altius Commercial |
$1,353.60
|
Rate for Payer: Beech Street Commercial |
$1,381.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,157.61
|
Rate for Payer: Cash Price |
$987.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,367.70
|
Rate for Payer: Cigna of WY Commercial |
$1,381.80
|
Rate for Payer: Entrust Commercial |
$1,339.50
|
Rate for Payer: First Choice Health Commercial |
$1,339.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,339.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.80
|
Rate for Payer: HealthUtah PPO |
$1,410.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,367.70
|
Rate for Payer: Multiplan Medicare/VA |
$776.91
|
Rate for Payer: One Health Plan of WY PPO |
$1,381.80
|
Rate for Payer: PacificSource Commercial |
$1,269.00
|
Rate for Payer: PHCS PPO |
$1,381.80
|
Rate for Payer: Three Rivers PPO |
$1,057.50
|
Rate for Payer: TriWest Veterans Administration |
$817.80
|
Rate for Payer: United Healthcare Commercial |
$1,226.70
|
Rate for Payer: United Healthcare Medicare |
$817.80
|
Rate for Payer: WINHealth Partners Commercial |
$1,381.80
|
Rate for Payer: Wise Provider Network Commercial |
$1,339.50
|
|
HC OB LABOR
|
Facility
|
IP
|
$1,410.00
|
|
Hospital Charge Code |
7210000005
|
Hospital Revenue Code
|
721
|
Min. Negotiated Rate |
$884.07 |
Max. Negotiated Rate |
$1,410.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,381.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,353.60
|
Rate for Payer: Altius Commercial |
$1,353.60
|
Rate for Payer: Beech Street Commercial |
$1,381.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,157.61
|
Rate for Payer: Cash Price |
$987.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,367.70
|
Rate for Payer: Cigna of WY Commercial |
$1,381.80
|
Rate for Payer: Entrust Commercial |
$1,339.50
|
Rate for Payer: First Choice Health Commercial |
$1,339.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,339.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$930.60
|
Rate for Payer: HealthUtah PPO |
$1,410.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,367.70
|
Rate for Payer: Multiplan Medicare/VA |
$884.07
|
Rate for Payer: One Health Plan of WY PPO |
$1,381.80
|
Rate for Payer: PacificSource Commercial |
$1,269.00
|
Rate for Payer: PHCS PPO |
$1,381.80
|
Rate for Payer: Three Rivers PPO |
$1,057.50
|
Rate for Payer: TriWest Veterans Administration |
$930.60
|
Rate for Payer: United Healthcare Commercial |
$1,226.70
|
Rate for Payer: United Healthcare Medicare |
$930.60
|
Rate for Payer: WINHealth Partners Commercial |
$1,339.50
|
Rate for Payer: Wise Provider Network Commercial |
$1,339.50
|
|
HC OB RECOVERY
|
Facility
|
IP
|
$825.00
|
|
Hospital Charge Code |
7200000001
|
Hospital Revenue Code
|
720
|
Min. Negotiated Rate |
$517.28 |
Max. Negotiated Rate |
$825.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$808.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$792.00
|
Rate for Payer: Altius Commercial |
$792.00
|
Rate for Payer: Beech Street Commercial |
$808.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$677.32
|
Rate for Payer: Cash Price |
$577.50
|
Rate for Payer: ChoiceCare Network Commercial |
$800.25
|
Rate for Payer: Cigna of WY Commercial |
$808.50
|
Rate for Payer: Entrust Commercial |
$783.75
|
Rate for Payer: First Choice Health Commercial |
$783.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$783.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$544.50
|
Rate for Payer: HealthUtah PPO |
$825.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$800.25
|
Rate for Payer: Multiplan Medicare/VA |
$517.28
|
Rate for Payer: One Health Plan of WY PPO |
$808.50
|
Rate for Payer: PacificSource Commercial |
$742.50
|
Rate for Payer: PHCS PPO |
$808.50
|
Rate for Payer: Three Rivers PPO |
$618.75
|
Rate for Payer: TriWest Veterans Administration |
$544.50
|
Rate for Payer: United Healthcare Commercial |
$717.75
|
Rate for Payer: United Healthcare Medicare |
$544.50
|
Rate for Payer: WINHealth Partners Commercial |
$783.75
|
Rate for Payer: Wise Provider Network Commercial |
$783.75
|
|
HC OB RECOVERY
|
Facility
|
OP
|
$825.00
|
|
Hospital Charge Code |
7200000001
|
Hospital Revenue Code
|
720
|
Min. Negotiated Rate |
$454.58 |
Max. Negotiated Rate |
$825.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$808.50
|
Rate for Payer: Aetna of WY Medicare |
$544.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$792.00
|
Rate for Payer: Altius Commercial |
$792.00
|
Rate for Payer: Beech Street Commercial |
$808.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$677.32
|
Rate for Payer: Cash Price |
$577.50
|
Rate for Payer: ChoiceCare Network Commercial |
$800.25
|
Rate for Payer: Cigna of WY Commercial |
$808.50
|
Rate for Payer: Entrust Commercial |
$783.75
|
Rate for Payer: First Choice Health Commercial |
$783.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$783.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.50
|
Rate for Payer: HealthUtah PPO |
$825.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$800.25
|
Rate for Payer: Multiplan Medicare/VA |
$454.58
|
Rate for Payer: One Health Plan of WY PPO |
$808.50
|
Rate for Payer: PacificSource Commercial |
$742.50
|
Rate for Payer: PHCS PPO |
$808.50
|
Rate for Payer: Three Rivers PPO |
$618.75
|
Rate for Payer: TriWest Veterans Administration |
$478.50
|
Rate for Payer: United Healthcare Commercial |
$717.75
|
Rate for Payer: United Healthcare Medicare |
$478.50
|
Rate for Payer: WINHealth Partners Commercial |
$808.50
|
Rate for Payer: Wise Provider Network Commercial |
$783.75
|
|
HC OBSTETRIC PANEL
|
Facility
|
OP
|
$375.00
|
|
Service Code
|
HCPCS 80055
|
Hospital Charge Code |
3018005501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$206.62 |
Max. Negotiated Rate |
$375.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
Rate for Payer: Aetna of WY Medicare |
$247.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
Rate for Payer: Altius Commercial |
$360.00
|
Rate for Payer: Beech Street Commercial |
$367.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
Rate for Payer: Cash Price |
$262.50
|
Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
Rate for Payer: Cigna of WY Commercial |
$367.50
|
Rate for Payer: Entrust Commercial |
$356.25
|
Rate for Payer: First Choice Health Commercial |
$356.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.50
|
Rate for Payer: HealthUtah PPO |
$375.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
Rate for Payer: Multiplan Medicare/VA |
$206.62
|
Rate for Payer: One Health Plan of WY PPO |
$367.50
|
Rate for Payer: PacificSource Commercial |
$337.50
|
Rate for Payer: PHCS PPO |
$367.50
|
Rate for Payer: Three Rivers PPO |
$281.25
|
Rate for Payer: TriWest Veterans Administration |
$217.50
|
Rate for Payer: United Healthcare Commercial |
$326.25
|
Rate for Payer: United Healthcare Medicare |
$217.50
|
Rate for Payer: WINHealth Partners Commercial |
$367.50
|
Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
HC OBSTETRIC PANEL
|
Facility
|
IP
|
$375.00
|
|
Service Code
|
HCPCS 80055
|
Hospital Charge Code |
3018005501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$235.12 |
Max. Negotiated Rate |
$375.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
Rate for Payer: Altius Commercial |
$360.00
|
Rate for Payer: Beech Street Commercial |
$367.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
Rate for Payer: Cash Price |
$262.50
|
Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
Rate for Payer: Cigna of WY Commercial |
$367.50
|
Rate for Payer: Entrust Commercial |
$356.25
|
Rate for Payer: First Choice Health Commercial |
$356.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.50
|
Rate for Payer: HealthUtah PPO |
$375.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
Rate for Payer: Multiplan Medicare/VA |
$235.12
|
Rate for Payer: One Health Plan of WY PPO |
$367.50
|
Rate for Payer: PacificSource Commercial |
$337.50
|
Rate for Payer: PHCS PPO |
$367.50
|
Rate for Payer: Three Rivers PPO |
$281.25
|
Rate for Payer: TriWest Veterans Administration |
$247.50
|
Rate for Payer: United Healthcare Commercial |
$326.25
|
Rate for Payer: United Healthcare Medicare |
$247.50
|
Rate for Payer: WINHealth Partners Commercial |
$356.25
|
Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
HC OB US < 14 WKS ADDL FETUS - US OB < 14 WEEKS EACH ADDITIONAL GEST
|
Facility
|
IP
|
$425.00
|
|
Service Code
|
HCPCS 76802
|
Hospital Charge Code |
4027680201
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$266.48 |
Max. Negotiated Rate |
$425.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
Rate for Payer: Altius Commercial |
$408.00
|
Rate for Payer: Beech Street Commercial |
$416.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
Rate for Payer: Cash Price |
$297.50
|
Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
Rate for Payer: Cigna of WY Commercial |
$416.50
|
Rate for Payer: Entrust Commercial |
$403.75
|
Rate for Payer: First Choice Health Commercial |
$403.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$280.50
|
Rate for Payer: HealthUtah PPO |
$425.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
Rate for Payer: Multiplan Medicare/VA |
$266.48
|
Rate for Payer: One Health Plan of WY PPO |
$416.50
|
Rate for Payer: PacificSource Commercial |
$382.50
|
Rate for Payer: PHCS PPO |
$416.50
|
Rate for Payer: Three Rivers PPO |
$318.75
|
Rate for Payer: TriWest Veterans Administration |
$280.50
|
Rate for Payer: United Healthcare Commercial |
$369.75
|
Rate for Payer: United Healthcare Medicare |
$280.50
|
Rate for Payer: WINHealth Partners Commercial |
$403.75
|
Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
HC OB US < 14 WKS ADDL FETUS - US OB < 14 WEEKS EACH ADDITIONAL GEST
|
Facility
|
OP
|
$425.00
|
|
Service Code
|
HCPCS 76802
|
Hospital Charge Code |
4027680201
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$234.18 |
Max. Negotiated Rate |
$425.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
Rate for Payer: Aetna of WY Medicare |
$280.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
Rate for Payer: Altius Commercial |
$408.00
|
Rate for Payer: Beech Street Commercial |
$416.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
Rate for Payer: Cash Price |
$297.50
|
Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
Rate for Payer: Cigna of WY Commercial |
$416.50
|
Rate for Payer: Entrust Commercial |
$403.75
|
Rate for Payer: First Choice Health Commercial |
$403.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.50
|
Rate for Payer: HealthUtah PPO |
$425.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
Rate for Payer: Multiplan Medicare/VA |
$234.18
|
Rate for Payer: One Health Plan of WY PPO |
$416.50
|
Rate for Payer: PacificSource Commercial |
$382.50
|
Rate for Payer: PHCS PPO |
$416.50
|
Rate for Payer: Three Rivers PPO |
$318.75
|
Rate for Payer: TriWest Veterans Administration |
$246.50
|
Rate for Payer: United Healthcare Commercial |
$369.75
|
Rate for Payer: United Healthcare Medicare |
$246.50
|
Rate for Payer: WINHealth Partners Commercial |
$416.50
|
Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
HC OB US >/= 14 WKS ADDL FETUS - US OB 14+ WEEKS EACH ADDITIONAL GEST
|
Facility
|
OP
|
$620.00
|
|
Service Code
|
HCPCS 76810
|
Hospital Charge Code |
4027681001
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$341.62 |
Max. Negotiated Rate |
$620.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
Rate for Payer: Aetna of WY Medicare |
$409.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$595.20
|
Rate for Payer: Altius Commercial |
$595.20
|
Rate for Payer: Beech Street Commercial |
$607.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.02
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
Rate for Payer: Cigna of WY Commercial |
$607.60
|
Rate for Payer: Entrust Commercial |
$589.00
|
Rate for Payer: First Choice Health Commercial |
$589.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.60
|
Rate for Payer: HealthUtah PPO |
$620.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
Rate for Payer: Multiplan Medicare/VA |
$341.62
|
Rate for Payer: One Health Plan of WY PPO |
$607.60
|
Rate for Payer: PacificSource Commercial |
$558.00
|
Rate for Payer: PHCS PPO |
$607.60
|
Rate for Payer: Three Rivers PPO |
$465.00
|
Rate for Payer: TriWest Veterans Administration |
$359.60
|
Rate for Payer: United Healthcare Commercial |
$539.40
|
Rate for Payer: United Healthcare Medicare |
$359.60
|
Rate for Payer: WINHealth Partners Commercial |
$607.60
|
Rate for Payer: Wise Provider Network Commercial |
$589.00
|
|
HC OB US >/= 14 WKS ADDL FETUS - US OB 14+ WEEKS EACH ADDITIONAL GEST
|
Facility
|
IP
|
$620.00
|
|
Service Code
|
HCPCS 76810
|
Hospital Charge Code |
4027681001
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$388.74 |
Max. Negotiated Rate |
$620.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$595.20
|
Rate for Payer: Altius Commercial |
$595.20
|
Rate for Payer: Beech Street Commercial |
$607.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.02
|
Rate for Payer: Cash Price |
$434.00
|
Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
Rate for Payer: Cigna of WY Commercial |
$607.60
|
Rate for Payer: Entrust Commercial |
$589.00
|
Rate for Payer: First Choice Health Commercial |
$589.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$409.20
|
Rate for Payer: HealthUtah PPO |
$620.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
Rate for Payer: Multiplan Medicare/VA |
$388.74
|
Rate for Payer: One Health Plan of WY PPO |
$607.60
|
Rate for Payer: PacificSource Commercial |
$558.00
|
Rate for Payer: PHCS PPO |
$607.60
|
Rate for Payer: Three Rivers PPO |
$465.00
|
Rate for Payer: TriWest Veterans Administration |
$409.20
|
Rate for Payer: United Healthcare Commercial |
$539.40
|
Rate for Payer: United Healthcare Medicare |
$409.20
|
Rate for Payer: WINHealth Partners Commercial |
$589.00
|
Rate for Payer: Wise Provider Network Commercial |
$589.00
|
|
HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST
|
Facility
|
IP
|
$520.00
|
|
Service Code
|
HCPCS 76801
|
Hospital Charge Code |
4027680101
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$326.04 |
Max. Negotiated Rate |
$520.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
Rate for Payer: Altius Commercial |
$499.20
|
Rate for Payer: Beech Street Commercial |
$509.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
Rate for Payer: Cash Price |
$364.00
|
Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
Rate for Payer: Cigna of WY Commercial |
$509.60
|
Rate for Payer: Entrust Commercial |
$494.00
|
Rate for Payer: First Choice Health Commercial |
$494.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
Rate for Payer: HealthUtah PPO |
$520.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
Rate for Payer: Multiplan Medicare/VA |
$326.04
|
Rate for Payer: One Health Plan of WY PPO |
$509.60
|
Rate for Payer: PacificSource Commercial |
$468.00
|
Rate for Payer: PHCS PPO |
$509.60
|
Rate for Payer: Three Rivers PPO |
$390.00
|
Rate for Payer: TriWest Veterans Administration |
$343.20
|
Rate for Payer: United Healthcare Commercial |
$452.40
|
Rate for Payer: United Healthcare Medicare |
$343.20
|
Rate for Payer: WINHealth Partners Commercial |
$494.00
|
Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
HC OB US < 14 WKS SINGLE FETUS - US OB < 14 WEEKS SINGLE OR FIRST GEST
|
Facility
|
OP
|
$520.00
|
|
Service Code
|
HCPCS 76801
|
Hospital Charge Code |
4027680101
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$286.52 |
Max. Negotiated Rate |
$520.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
Rate for Payer: Aetna of WY Medicare |
$343.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
Rate for Payer: Altius Commercial |
$499.20
|
Rate for Payer: Beech Street Commercial |
$509.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
Rate for Payer: Cash Price |
$364.00
|
Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
Rate for Payer: Cigna of WY Commercial |
$509.60
|
Rate for Payer: Entrust Commercial |
$494.00
|
Rate for Payer: First Choice Health Commercial |
$494.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
Rate for Payer: HealthUtah PPO |
$520.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
Rate for Payer: Multiplan Medicare/VA |
$286.52
|
Rate for Payer: One Health Plan of WY PPO |
$509.60
|
Rate for Payer: PacificSource Commercial |
$468.00
|
Rate for Payer: PHCS PPO |
$509.60
|
Rate for Payer: Three Rivers PPO |
$390.00
|
Rate for Payer: TriWest Veterans Administration |
$301.60
|
Rate for Payer: United Healthcare Commercial |
$452.40
|
Rate for Payer: United Healthcare Medicare |
$301.60
|
Rate for Payer: WINHealth Partners Commercial |
$509.60
|
Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST
|
Facility
|
OP
|
$585.00
|
|
Service Code
|
HCPCS 76805
|
Hospital Charge Code |
4027680501
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$322.34 |
Max. Negotiated Rate |
$585.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
Rate for Payer: Aetna of WY Medicare |
$386.10
|
Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
Rate for Payer: Altius Commercial |
$561.60
|
Rate for Payer: Beech Street Commercial |
$573.30
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
Rate for Payer: Cash Price |
$409.50
|
Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
Rate for Payer: Cigna of WY Commercial |
$573.30
|
Rate for Payer: Entrust Commercial |
$555.75
|
Rate for Payer: First Choice Health Commercial |
$555.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.30
|
Rate for Payer: HealthUtah PPO |
$585.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
Rate for Payer: Multiplan Medicare/VA |
$322.34
|
Rate for Payer: One Health Plan of WY PPO |
$573.30
|
Rate for Payer: PacificSource Commercial |
$526.50
|
Rate for Payer: PHCS PPO |
$573.30
|
Rate for Payer: Three Rivers PPO |
$438.75
|
Rate for Payer: TriWest Veterans Administration |
$339.30
|
Rate for Payer: United Healthcare Commercial |
$508.95
|
Rate for Payer: United Healthcare Medicare |
$339.30
|
Rate for Payer: WINHealth Partners Commercial |
$573.30
|
Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
HC OB US >/= 14 WKS SNGL FETUS - US OB 14+ WEEKS SINGLE OR FIRST GEST
|
Facility
|
IP
|
$585.00
|
|
Service Code
|
HCPCS 76805
|
Hospital Charge Code |
4027680501
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$366.80 |
Max. Negotiated Rate |
$585.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
Rate for Payer: Altius Commercial |
$561.60
|
Rate for Payer: Beech Street Commercial |
$573.30
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
Rate for Payer: Cash Price |
$409.50
|
Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
Rate for Payer: Cigna of WY Commercial |
$573.30
|
Rate for Payer: Entrust Commercial |
$555.75
|
Rate for Payer: First Choice Health Commercial |
$555.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.10
|
Rate for Payer: HealthUtah PPO |
$585.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
Rate for Payer: Multiplan Medicare/VA |
$366.80
|
Rate for Payer: One Health Plan of WY PPO |
$573.30
|
Rate for Payer: PacificSource Commercial |
$526.50
|
Rate for Payer: PHCS PPO |
$573.30
|
Rate for Payer: Three Rivers PPO |
$438.75
|
Rate for Payer: TriWest Veterans Administration |
$386.10
|
Rate for Payer: United Healthcare Commercial |
$508.95
|
Rate for Payer: United Healthcare Medicare |
$386.10
|
Rate for Payer: WINHealth Partners Commercial |
$555.75
|
Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
HC OB US DETAILED ADDL FETUS - US OB DETAIL FETAL ANAT EA ADDL GEST
|
Facility
|
IP
|
$1,355.00
|
|
Service Code
|
HCPCS 76812
|
Hospital Charge Code |
4027681201
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$849.58 |
Max. Negotiated Rate |
$1,355.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,327.90
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,300.80
|
Rate for Payer: Altius Commercial |
$1,300.80
|
Rate for Payer: Beech Street Commercial |
$1,327.90
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,112.46
|
Rate for Payer: Cash Price |
$948.50
|
Rate for Payer: ChoiceCare Network Commercial |
$1,314.35
|
Rate for Payer: Cigna of WY Commercial |
$1,327.90
|
Rate for Payer: Entrust Commercial |
$1,287.25
|
Rate for Payer: First Choice Health Commercial |
$1,287.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,287.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$894.30
|
Rate for Payer: HealthUtah PPO |
$1,355.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,314.35
|
Rate for Payer: Multiplan Medicare/VA |
$849.58
|
Rate for Payer: One Health Plan of WY PPO |
$1,327.90
|
Rate for Payer: PacificSource Commercial |
$1,219.50
|
Rate for Payer: PHCS PPO |
$1,327.90
|
Rate for Payer: Three Rivers PPO |
$1,016.25
|
Rate for Payer: TriWest Veterans Administration |
$894.30
|
Rate for Payer: United Healthcare Commercial |
$1,178.85
|
Rate for Payer: United Healthcare Medicare |
$894.30
|
Rate for Payer: WINHealth Partners Commercial |
$1,287.25
|
Rate for Payer: Wise Provider Network Commercial |
$1,287.25
|
|
HC OB US DETAILED ADDL FETUS - US OB DETAIL FETAL ANAT EA ADDL GEST
|
Facility
|
OP
|
$1,355.00
|
|
Service Code
|
HCPCS 76812
|
Hospital Charge Code |
4027681201
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$746.60 |
Max. Negotiated Rate |
$1,355.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,327.90
|
Rate for Payer: Aetna of WY Medicare |
$894.30
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,300.80
|
Rate for Payer: Altius Commercial |
$1,300.80
|
Rate for Payer: Beech Street Commercial |
$1,327.90
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,112.46
|
Rate for Payer: Cash Price |
$948.50
|
Rate for Payer: ChoiceCare Network Commercial |
$1,314.35
|
Rate for Payer: Cigna of WY Commercial |
$1,327.90
|
Rate for Payer: Entrust Commercial |
$1,287.25
|
Rate for Payer: First Choice Health Commercial |
$1,287.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,287.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$785.90
|
Rate for Payer: HealthUtah PPO |
$1,355.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,314.35
|
Rate for Payer: Multiplan Medicare/VA |
$746.60
|
Rate for Payer: One Health Plan of WY PPO |
$1,327.90
|
Rate for Payer: PacificSource Commercial |
$1,219.50
|
Rate for Payer: PHCS PPO |
$1,327.90
|
Rate for Payer: Three Rivers PPO |
$1,016.25
|
Rate for Payer: TriWest Veterans Administration |
$785.90
|
Rate for Payer: United Healthcare Commercial |
$1,178.85
|
Rate for Payer: United Healthcare Medicare |
$785.90
|
Rate for Payer: WINHealth Partners Commercial |
$1,327.90
|
Rate for Payer: Wise Provider Network Commercial |
$1,287.25
|
|
HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST
|
Facility
|
OP
|
$1,120.00
|
|
Service Code
|
HCPCS 76811
|
Hospital Charge Code |
4027681101
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$617.12 |
Max. Negotiated Rate |
$1,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
Rate for Payer: Aetna of WY Medicare |
$739.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
Rate for Payer: Altius Commercial |
$1,075.20
|
Rate for Payer: Beech Street Commercial |
$1,097.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
Rate for Payer: Cash Price |
$784.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
Rate for Payer: Entrust Commercial |
$1,064.00
|
Rate for Payer: First Choice Health Commercial |
$1,064.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
Rate for Payer: HealthUtah PPO |
$1,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
Rate for Payer: Multiplan Medicare/VA |
$617.12
|
Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
Rate for Payer: PacificSource Commercial |
$1,008.00
|
Rate for Payer: PHCS PPO |
$1,097.60
|
Rate for Payer: Three Rivers PPO |
$840.00
|
Rate for Payer: TriWest Veterans Administration |
$649.60
|
Rate for Payer: United Healthcare Commercial |
$974.40
|
Rate for Payer: United Healthcare Medicare |
$649.60
|
Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
HC OB US DETAILED SNGL FETUS - US OB DETAIL FETAL ANAT SING OR 1ST GEST
|
Facility
|
IP
|
$1,120.00
|
|
Service Code
|
HCPCS 76811
|
Hospital Charge Code |
4027681101
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$702.24 |
Max. Negotiated Rate |
$1,120.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
Rate for Payer: Altius Commercial |
$1,075.20
|
Rate for Payer: Beech Street Commercial |
$1,097.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
Rate for Payer: Cash Price |
$784.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
Rate for Payer: Entrust Commercial |
$1,064.00
|
Rate for Payer: First Choice Health Commercial |
$1,064.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
Rate for Payer: HealthUtah PPO |
$1,120.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
Rate for Payer: Multiplan Medicare/VA |
$702.24
|
Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
Rate for Payer: PacificSource Commercial |
$1,008.00
|
Rate for Payer: PHCS PPO |
$1,097.60
|
Rate for Payer: Three Rivers PPO |
$840.00
|
Rate for Payer: TriWest Veterans Administration |
$739.20
|
Rate for Payer: United Healthcare Commercial |
$974.40
|
Rate for Payer: United Healthcare Medicare |
$739.20
|
Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|