|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES COMPLEMENT FIXATION
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES COMPLEMENT FIXATION
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.02
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGG
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGG
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGM
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IGM
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IMMUNODIFFUSION
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES IMMUNODIFFUSION
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
3028663502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.02
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - COENZYME Q10
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - COENZYME Q10
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - MDMA ECSTASY UR
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - MDMA ECSTASY UR
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - TETRAHYDROALDOSTERON
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - TETRAHYDROALDOSTERON
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
3028615701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
3028615701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC COLONOSCOPE/EGD PROCEDURE
|
Facility
|
IP
|
$920.00
|
|
| Hospital Charge Code |
3600000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.84 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.20
|
| Rate for Payer: Altius Commercial |
$883.20
|
| Rate for Payer: Beech Street Commercial |
$901.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.32
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.40
|
| Rate for Payer: Cigna of WY Commercial |
$901.60
|
| Rate for Payer: Entrust Commercial |
$874.00
|
| Rate for Payer: First Choice Health Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.20
|
| Rate for Payer: HealthUtah PPO |
$920.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.40
|
| Rate for Payer: Multiplan Medicare/VA |
$576.84
|
| Rate for Payer: One Health Plan of WY PPO |
$901.60
|
| Rate for Payer: PacificSource Commercial |
$828.00
|
| Rate for Payer: PHCS PPO |
$901.60
|
| Rate for Payer: Three Rivers PPO |
$690.00
|
| Rate for Payer: TriWest Veterans Administration |
$607.20
|
| Rate for Payer: United Healthcare Commercial |
$800.40
|
| Rate for Payer: United Healthcare Medicare |
$607.20
|
| Rate for Payer: WINHealth Partners Commercial |
$874.00
|
| Rate for Payer: Wise Provider Network Commercial |
$874.00
|
|
|
HC COLONOSCOPE/EGD PROCEDURE
|
Facility
|
OP
|
$920.00
|
|
| Hospital Charge Code |
3600000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$506.92 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.60
|
| Rate for Payer: Aetna of WY Medicare |
$607.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.20
|
| Rate for Payer: Altius Commercial |
$883.20
|
| Rate for Payer: Beech Street Commercial |
$901.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.32
|
| Rate for Payer: Cash Price |
$644.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.40
|
| Rate for Payer: Cigna of WY Commercial |
$901.60
|
| Rate for Payer: Entrust Commercial |
$874.00
|
| Rate for Payer: First Choice Health Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$874.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$533.60
|
| Rate for Payer: HealthUtah PPO |
$920.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.40
|
| Rate for Payer: Multiplan Medicare/VA |
$506.92
|
| Rate for Payer: One Health Plan of WY PPO |
$901.60
|
| Rate for Payer: PacificSource Commercial |
$828.00
|
| Rate for Payer: PHCS PPO |
$901.60
|
| Rate for Payer: Three Rivers PPO |
$690.00
|
| Rate for Payer: TriWest Veterans Administration |
$533.60
|
| Rate for Payer: United Healthcare Commercial |
$800.40
|
| Rate for Payer: United Healthcare Medicare |
$533.60
|
| Rate for Payer: WINHealth Partners Commercial |
$901.60
|
| Rate for Payer: Wise Provider Network Commercial |
$874.00
|
|
|
HC COLONOSCOPE PROCEDURE
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
3600000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COLONOSCOPE PROCEDURE
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
3600000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$129.60
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.84
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$74.38
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
5105745601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.92
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.32
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$63.95
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.32
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$67.32
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
