HC COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$102.00
|
|
Service Code
|
HCPCS 57456
|
Hospital Charge Code |
5105745601
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$56.20 |
Max. Negotiated Rate |
$102.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
Rate for Payer: Aetna of WY Medicare |
$67.32
|
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 |
$59.16
|
Rate for Payer: HealthUtah PPO |
$102.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
Rate for Payer: Multiplan Medicare/VA |
$56.20
|
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 |
$59.16
|
Rate for Payer: United Healthcare Commercial |
$88.74
|
Rate for Payer: United Healthcare Medicare |
$59.16
|
Rate for Payer: WINHealth Partners Commercial |
$99.96
|
Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
HC COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Facility
|
OP
|
$92.00
|
|
Service Code
|
HCPCS 57452
|
Hospital Charge Code |
5105745201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$50.69 |
Max. Negotiated Rate |
$92.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
Rate for Payer: Aetna of WY Medicare |
$60.72
|
Rate for Payer: Altius Auto/Workers Compensation |
$88.32
|
Rate for Payer: Altius Commercial |
$88.32
|
Rate for Payer: Beech Street Commercial |
$90.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.53
|
Rate for Payer: Cash Price |
$64.40
|
Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
Rate for Payer: Cigna of WY Commercial |
$90.16
|
Rate for Payer: Entrust Commercial |
$87.40
|
Rate for Payer: First Choice Health Commercial |
$87.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.36
|
Rate for Payer: HealthUtah PPO |
$92.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
Rate for Payer: Multiplan Medicare/VA |
$50.69
|
Rate for Payer: One Health Plan of WY PPO |
$90.16
|
Rate for Payer: PacificSource Commercial |
$82.80
|
Rate for Payer: PHCS PPO |
$90.16
|
Rate for Payer: Three Rivers PPO |
$69.00
|
Rate for Payer: TriWest Veterans Administration |
$53.36
|
Rate for Payer: United Healthcare Commercial |
$80.04
|
Rate for Payer: United Healthcare Medicare |
$53.36
|
Rate for Payer: WINHealth Partners Commercial |
$90.16
|
Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
HC COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Facility
|
IP
|
$92.00
|
|
Service Code
|
HCPCS 57452
|
Hospital Charge Code |
5105745201
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$57.68 |
Max. Negotiated Rate |
$92.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
Rate for Payer: Altius Auto/Workers Compensation |
$88.32
|
Rate for Payer: Altius Commercial |
$88.32
|
Rate for Payer: Beech Street Commercial |
$90.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.53
|
Rate for Payer: Cash Price |
$64.40
|
Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
Rate for Payer: Cigna of WY Commercial |
$90.16
|
Rate for Payer: Entrust Commercial |
$87.40
|
Rate for Payer: First Choice Health Commercial |
$87.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.72
|
Rate for Payer: HealthUtah PPO |
$92.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
Rate for Payer: Multiplan Medicare/VA |
$57.68
|
Rate for Payer: One Health Plan of WY PPO |
$90.16
|
Rate for Payer: PacificSource Commercial |
$82.80
|
Rate for Payer: PHCS PPO |
$90.16
|
Rate for Payer: Three Rivers PPO |
$69.00
|
Rate for Payer: TriWest Veterans Administration |
$60.72
|
Rate for Payer: United Healthcare Commercial |
$80.04
|
Rate for Payer: United Healthcare Medicare |
$60.72
|
Rate for Payer: WINHealth Partners Commercial |
$87.40
|
Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
HC COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Facility
|
OP
|
$111.00
|
|
Service Code
|
HCPCS 57455
|
Hospital Charge Code |
5105745501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$61.16 |
Max. Negotiated Rate |
$111.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
Rate for Payer: Aetna of WY Medicare |
$73.26
|
Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
Rate for Payer: Altius Commercial |
$106.56
|
Rate for Payer: Beech Street Commercial |
$108.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
Rate for Payer: Cash Price |
$77.70
|
Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
Rate for Payer: Cigna of WY Commercial |
$108.78
|
Rate for Payer: Entrust Commercial |
$105.45
|
Rate for Payer: First Choice Health Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.38
|
Rate for Payer: HealthUtah PPO |
$111.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
Rate for Payer: Multiplan Medicare/VA |
$61.16
|
Rate for Payer: One Health Plan of WY PPO |
$108.78
|
Rate for Payer: PacificSource Commercial |
$99.90
|
Rate for Payer: PHCS PPO |
$108.78
|
Rate for Payer: Three Rivers PPO |
$83.25
|
Rate for Payer: TriWest Veterans Administration |
$64.38
|
Rate for Payer: United Healthcare Commercial |
$96.57
|
Rate for Payer: United Healthcare Medicare |
$64.38
|
Rate for Payer: WINHealth Partners Commercial |
$108.78
|
Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
HC COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Facility
|
IP
|
$111.00
|
|
Service Code
|
HCPCS 57455
|
Hospital Charge Code |
5105745501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$69.60 |
Max. Negotiated Rate |
$111.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
Rate for Payer: Altius Commercial |
$106.56
|
Rate for Payer: Beech Street Commercial |
$108.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
Rate for Payer: Cash Price |
$77.70
|
Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
Rate for Payer: Cigna of WY Commercial |
$108.78
|
Rate for Payer: Entrust Commercial |
$105.45
|
Rate for Payer: First Choice Health Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.26
|
Rate for Payer: HealthUtah PPO |
$111.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
Rate for Payer: Multiplan Medicare/VA |
$69.60
|
Rate for Payer: One Health Plan of WY PPO |
$108.78
|
Rate for Payer: PacificSource Commercial |
$99.90
|
Rate for Payer: PHCS PPO |
$108.78
|
Rate for Payer: Three Rivers PPO |
$83.25
|
Rate for Payer: TriWest Veterans Administration |
$73.26
|
Rate for Payer: United Healthcare Commercial |
$96.57
|
Rate for Payer: United Healthcare Medicare |
$73.26
|
Rate for Payer: WINHealth Partners Commercial |
$105.45
|
Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
HC COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Facility
|
IP
|
$187.00
|
|
Service Code
|
HCPCS 57461
|
Hospital Charge Code |
5105746101
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$117.25 |
Max. Negotiated Rate |
$187.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.26
|
Rate for Payer: Altius Auto/Workers Compensation |
$179.52
|
Rate for Payer: Altius Commercial |
$179.52
|
Rate for Payer: Beech Street Commercial |
$183.26
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.53
|
Rate for Payer: Cash Price |
$130.90
|
Rate for Payer: ChoiceCare Network Commercial |
$181.39
|
Rate for Payer: Cigna of WY Commercial |
$183.26
|
Rate for Payer: Entrust Commercial |
$177.65
|
Rate for Payer: First Choice Health Commercial |
$177.65
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.65
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.42
|
Rate for Payer: HealthUtah PPO |
$187.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.39
|
Rate for Payer: Multiplan Medicare/VA |
$117.25
|
Rate for Payer: One Health Plan of WY PPO |
$183.26
|
Rate for Payer: PacificSource Commercial |
$168.30
|
Rate for Payer: PHCS PPO |
$183.26
|
Rate for Payer: Three Rivers PPO |
$140.25
|
Rate for Payer: TriWest Veterans Administration |
$123.42
|
Rate for Payer: United Healthcare Commercial |
$162.69
|
Rate for Payer: United Healthcare Medicare |
$123.42
|
Rate for Payer: WINHealth Partners Commercial |
$177.65
|
Rate for Payer: Wise Provider Network Commercial |
$177.65
|
|
HC COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Facility
|
OP
|
$187.00
|
|
Service Code
|
HCPCS 57461
|
Hospital Charge Code |
5105746101
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$103.04 |
Max. Negotiated Rate |
$187.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.26
|
Rate for Payer: Aetna of WY Medicare |
$123.42
|
Rate for Payer: Altius Auto/Workers Compensation |
$179.52
|
Rate for Payer: Altius Commercial |
$179.52
|
Rate for Payer: Beech Street Commercial |
$183.26
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.53
|
Rate for Payer: Cash Price |
$130.90
|
Rate for Payer: ChoiceCare Network Commercial |
$181.39
|
Rate for Payer: Cigna of WY Commercial |
$183.26
|
Rate for Payer: Entrust Commercial |
$177.65
|
Rate for Payer: First Choice Health Commercial |
$177.65
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.65
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.46
|
Rate for Payer: HealthUtah PPO |
$187.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.39
|
Rate for Payer: Multiplan Medicare/VA |
$103.04
|
Rate for Payer: One Health Plan of WY PPO |
$183.26
|
Rate for Payer: PacificSource Commercial |
$168.30
|
Rate for Payer: PHCS PPO |
$183.26
|
Rate for Payer: Three Rivers PPO |
$140.25
|
Rate for Payer: TriWest Veterans Administration |
$108.46
|
Rate for Payer: United Healthcare Commercial |
$162.69
|
Rate for Payer: United Healthcare Medicare |
$108.46
|
Rate for Payer: WINHealth Partners Commercial |
$183.26
|
Rate for Payer: Wise Provider Network Commercial |
$177.65
|
|
HC COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Facility
|
IP
|
$162.00
|
|
Service Code
|
HCPCS 57460
|
Hospital Charge Code |
5105746001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$101.57 |
Max. Negotiated Rate |
$162.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
Rate for Payer: Altius Commercial |
$155.52
|
Rate for Payer: Beech Street Commercial |
$158.76
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
Rate for Payer: Cash Price |
$113.40
|
Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
Rate for Payer: Cigna of WY Commercial |
$158.76
|
Rate for Payer: Entrust Commercial |
$153.90
|
Rate for Payer: First Choice Health Commercial |
$153.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.92
|
Rate for Payer: HealthUtah PPO |
$162.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
Rate for Payer: Multiplan Medicare/VA |
$101.57
|
Rate for Payer: One Health Plan of WY PPO |
$158.76
|
Rate for Payer: PacificSource Commercial |
$145.80
|
Rate for Payer: PHCS PPO |
$158.76
|
Rate for Payer: Three Rivers PPO |
$121.50
|
Rate for Payer: TriWest Veterans Administration |
$106.92
|
Rate for Payer: United Healthcare Commercial |
$140.94
|
Rate for Payer: United Healthcare Medicare |
$106.92
|
Rate for Payer: WINHealth Partners Commercial |
$153.90
|
Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
HC COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Facility
|
OP
|
$162.00
|
|
Service Code
|
HCPCS 57460
|
Hospital Charge Code |
5105746001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$89.26 |
Max. Negotiated Rate |
$162.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
Rate for Payer: Aetna of WY Medicare |
$106.92
|
Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
Rate for Payer: Altius Commercial |
$155.52
|
Rate for Payer: Beech Street Commercial |
$158.76
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
Rate for Payer: Cash Price |
$113.40
|
Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
Rate for Payer: Cigna of WY Commercial |
$158.76
|
Rate for Payer: Entrust Commercial |
$153.90
|
Rate for Payer: First Choice Health Commercial |
$153.90
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.96
|
Rate for Payer: HealthUtah PPO |
$162.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
Rate for Payer: Multiplan Medicare/VA |
$89.26
|
Rate for Payer: One Health Plan of WY PPO |
$158.76
|
Rate for Payer: PacificSource Commercial |
$145.80
|
Rate for Payer: PHCS PPO |
$158.76
|
Rate for Payer: Three Rivers PPO |
$121.50
|
Rate for Payer: TriWest Veterans Administration |
$93.96
|
Rate for Payer: United Healthcare Commercial |
$140.94
|
Rate for Payer: United Healthcare Medicare |
$93.96
|
Rate for Payer: WINHealth Partners Commercial |
$158.76
|
Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
HC COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT
|
Facility
|
IP
|
$91.00
|
|
Service Code
|
HCPCS 57420
|
Hospital Charge Code |
5105742001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$57.06 |
Max. Negotiated Rate |
$91.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
Rate for Payer: Altius Auto/Workers Compensation |
$87.36
|
Rate for Payer: Altius Commercial |
$87.36
|
Rate for Payer: Beech Street Commercial |
$89.18
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.71
|
Rate for Payer: Cash Price |
$63.70
|
Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
Rate for Payer: Cigna of WY Commercial |
$89.18
|
Rate for Payer: Entrust Commercial |
$86.45
|
Rate for Payer: First Choice Health Commercial |
$86.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.06
|
Rate for Payer: HealthUtah PPO |
$91.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
Rate for Payer: Multiplan Medicare/VA |
$57.06
|
Rate for Payer: One Health Plan of WY PPO |
$89.18
|
Rate for Payer: PacificSource Commercial |
$81.90
|
Rate for Payer: PHCS PPO |
$89.18
|
Rate for Payer: Three Rivers PPO |
$68.25
|
Rate for Payer: TriWest Veterans Administration |
$60.06
|
Rate for Payer: United Healthcare Commercial |
$79.17
|
Rate for Payer: United Healthcare Medicare |
$60.06
|
Rate for Payer: WINHealth Partners Commercial |
$86.45
|
Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
HC COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT
|
Facility
|
OP
|
$91.00
|
|
Service Code
|
HCPCS 57420
|
Hospital Charge Code |
5105742001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$50.14 |
Max. Negotiated Rate |
$91.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
Rate for Payer: Aetna of WY Medicare |
$60.06
|
Rate for Payer: Altius Auto/Workers Compensation |
$87.36
|
Rate for Payer: Altius Commercial |
$87.36
|
Rate for Payer: Beech Street Commercial |
$89.18
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.71
|
Rate for Payer: Cash Price |
$63.70
|
Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
Rate for Payer: Cigna of WY Commercial |
$89.18
|
Rate for Payer: Entrust Commercial |
$86.45
|
Rate for Payer: First Choice Health Commercial |
$86.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.78
|
Rate for Payer: HealthUtah PPO |
$91.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
Rate for Payer: Multiplan Medicare/VA |
$50.14
|
Rate for Payer: One Health Plan of WY PPO |
$89.18
|
Rate for Payer: PacificSource Commercial |
$81.90
|
Rate for Payer: PHCS PPO |
$89.18
|
Rate for Payer: Three Rivers PPO |
$68.25
|
Rate for Payer: TriWest Veterans Administration |
$52.78
|
Rate for Payer: United Healthcare Commercial |
$79.17
|
Rate for Payer: United Healthcare Medicare |
$52.78
|
Rate for Payer: WINHealth Partners Commercial |
$89.18
|
Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
HC COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Facility
|
OP
|
$124.00
|
|
Service Code
|
HCPCS 57421
|
Hospital Charge Code |
5105742101
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$68.32 |
Max. Negotiated Rate |
$124.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
Rate for Payer: Aetna of WY Medicare |
$81.84
|
Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
Rate for Payer: Altius Commercial |
$119.04
|
Rate for Payer: Beech Street Commercial |
$121.52
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
Rate for Payer: Cash Price |
$86.80
|
Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
Rate for Payer: Cigna of WY Commercial |
$121.52
|
Rate for Payer: Entrust Commercial |
$117.80
|
Rate for Payer: First Choice Health Commercial |
$117.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.92
|
Rate for Payer: HealthUtah PPO |
$124.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
Rate for Payer: Multiplan Medicare/VA |
$68.32
|
Rate for Payer: One Health Plan of WY PPO |
$121.52
|
Rate for Payer: PacificSource Commercial |
$111.60
|
Rate for Payer: PHCS PPO |
$121.52
|
Rate for Payer: Three Rivers PPO |
$93.00
|
Rate for Payer: TriWest Veterans Administration |
$71.92
|
Rate for Payer: United Healthcare Commercial |
$107.88
|
Rate for Payer: United Healthcare Medicare |
$71.92
|
Rate for Payer: WINHealth Partners Commercial |
$121.52
|
Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
HC COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Facility
|
IP
|
$124.00
|
|
Service Code
|
HCPCS 57421
|
Hospital Charge Code |
5105742101
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$77.75 |
Max. Negotiated Rate |
$124.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
Rate for Payer: Altius Commercial |
$119.04
|
Rate for Payer: Beech Street Commercial |
$121.52
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
Rate for Payer: Cash Price |
$86.80
|
Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
Rate for Payer: Cigna of WY Commercial |
$121.52
|
Rate for Payer: Entrust Commercial |
$117.80
|
Rate for Payer: First Choice Health Commercial |
$117.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.84
|
Rate for Payer: HealthUtah PPO |
$124.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
Rate for Payer: Multiplan Medicare/VA |
$77.75
|
Rate for Payer: One Health Plan of WY PPO |
$121.52
|
Rate for Payer: PacificSource Commercial |
$111.60
|
Rate for Payer: PHCS PPO |
$121.52
|
Rate for Payer: Three Rivers PPO |
$93.00
|
Rate for Payer: TriWest Veterans Administration |
$81.84
|
Rate for Payer: United Healthcare Commercial |
$107.88
|
Rate for Payer: United Healthcare Medicare |
$81.84
|
Rate for Payer: WINHealth Partners Commercial |
$117.80
|
Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
HC COLUMN CHROMATOGRAPHY NES - PRPHYRINS FRACTIONATED
|
Facility
|
OP
|
$475.00
|
|
Service Code
|
HCPCS 85242
|
Hospital Charge Code |
3058524201
|
Hospital Revenue Code
|
305
|
Min. Negotiated Rate |
$261.72 |
Max. Negotiated Rate |
$475.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
Rate for Payer: Aetna of WY Medicare |
$313.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
Rate for Payer: Altius Commercial |
$456.00
|
Rate for Payer: Beech Street Commercial |
$465.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
Rate for Payer: Cash Price |
$332.50
|
Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
Rate for Payer: Cigna of WY Commercial |
$465.50
|
Rate for Payer: Entrust Commercial |
$451.25
|
Rate for Payer: First Choice Health Commercial |
$451.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.50
|
Rate for Payer: HealthUtah PPO |
$475.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
Rate for Payer: Multiplan Medicare/VA |
$261.72
|
Rate for Payer: One Health Plan of WY PPO |
$465.50
|
Rate for Payer: PacificSource Commercial |
$427.50
|
Rate for Payer: PHCS PPO |
$465.50
|
Rate for Payer: Three Rivers PPO |
$356.25
|
Rate for Payer: TriWest Veterans Administration |
$275.50
|
Rate for Payer: United Healthcare Commercial |
$413.25
|
Rate for Payer: United Healthcare Medicare |
$275.50
|
Rate for Payer: WINHealth Partners Commercial |
$465.50
|
Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
HC COLUMN CHROMATOGRAPHY NES - PRPHYRINS FRACTIONATED
|
Facility
|
IP
|
$475.00
|
|
Service Code
|
HCPCS 85242
|
Hospital Charge Code |
3058524201
|
Hospital Revenue Code
|
305
|
Min. Negotiated Rate |
$297.82 |
Max. Negotiated Rate |
$475.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
Rate for Payer: Altius Commercial |
$456.00
|
Rate for Payer: Beech Street Commercial |
$465.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
Rate for Payer: Cash Price |
$332.50
|
Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
Rate for Payer: Cigna of WY Commercial |
$465.50
|
Rate for Payer: Entrust Commercial |
$451.25
|
Rate for Payer: First Choice Health Commercial |
$451.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.50
|
Rate for Payer: HealthUtah PPO |
$475.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
Rate for Payer: Multiplan Medicare/VA |
$297.82
|
Rate for Payer: One Health Plan of WY PPO |
$465.50
|
Rate for Payer: PacificSource Commercial |
$427.50
|
Rate for Payer: PHCS PPO |
$465.50
|
Rate for Payer: Three Rivers PPO |
$356.25
|
Rate for Payer: TriWest Veterans Administration |
$313.50
|
Rate for Payer: United Healthcare Commercial |
$413.25
|
Rate for Payer: United Healthcare Medicare |
$313.50
|
Rate for Payer: WINHealth Partners Commercial |
$451.25
|
Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
HC COMPATIBILITY EACH UNIT ELECTRONIC
|
Facility
|
IP
|
$525.00
|
|
Service Code
|
HCPCS 86923
|
Hospital Charge Code |
3008692301
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$329.18 |
Max. Negotiated Rate |
$525.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
Rate for Payer: Altius Commercial |
$504.00
|
Rate for Payer: Beech Street Commercial |
$514.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
Rate for Payer: Cash Price |
$367.50
|
Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
Rate for Payer: Cigna of WY Commercial |
$514.50
|
Rate for Payer: Entrust Commercial |
$498.75
|
Rate for Payer: First Choice Health Commercial |
$498.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.50
|
Rate for Payer: HealthUtah PPO |
$525.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
Rate for Payer: Multiplan Medicare/VA |
$329.18
|
Rate for Payer: One Health Plan of WY PPO |
$514.50
|
Rate for Payer: PacificSource Commercial |
$472.50
|
Rate for Payer: PHCS PPO |
$514.50
|
Rate for Payer: Three Rivers PPO |
$393.75
|
Rate for Payer: TriWest Veterans Administration |
$346.50
|
Rate for Payer: United Healthcare Commercial |
$456.75
|
Rate for Payer: United Healthcare Medicare |
$346.50
|
Rate for Payer: WINHealth Partners Commercial |
$498.75
|
Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
HC COMPATIBILITY EACH UNIT ELECTRONIC
|
Facility
|
OP
|
$525.00
|
|
Service Code
|
HCPCS 86923
|
Hospital Charge Code |
3008692301
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$289.28 |
Max. Negotiated Rate |
$525.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
Rate for Payer: Aetna of WY Medicare |
$346.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$504.00
|
Rate for Payer: Altius Commercial |
$504.00
|
Rate for Payer: Beech Street Commercial |
$514.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$431.02
|
Rate for Payer: Cash Price |
$367.50
|
Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
Rate for Payer: Cigna of WY Commercial |
$514.50
|
Rate for Payer: Entrust Commercial |
$498.75
|
Rate for Payer: First Choice Health Commercial |
$498.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.50
|
Rate for Payer: HealthUtah PPO |
$525.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
Rate for Payer: Multiplan Medicare/VA |
$289.28
|
Rate for Payer: One Health Plan of WY PPO |
$514.50
|
Rate for Payer: PacificSource Commercial |
$472.50
|
Rate for Payer: PHCS PPO |
$514.50
|
Rate for Payer: Three Rivers PPO |
$393.75
|
Rate for Payer: TriWest Veterans Administration |
$304.50
|
Rate for Payer: United Healthcare Commercial |
$456.75
|
Rate for Payer: United Healthcare Medicare |
$304.50
|
Rate for Payer: WINHealth Partners Commercial |
$514.50
|
Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
HC COMPATIBILITY TEST ANTIGLOB TECH
|
Facility
|
IP
|
$590.00
|
|
Service Code
|
HCPCS 86922
|
Hospital Charge Code |
3008692201
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$369.93 |
Max. Negotiated Rate |
$590.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
Rate for Payer: Altius Commercial |
$566.40
|
Rate for Payer: Beech Street Commercial |
$578.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
Rate for Payer: Cash Price |
$413.00
|
Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
Rate for Payer: Cigna of WY Commercial |
$578.20
|
Rate for Payer: Entrust Commercial |
$560.50
|
Rate for Payer: First Choice Health Commercial |
$560.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.40
|
Rate for Payer: HealthUtah PPO |
$590.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
Rate for Payer: Multiplan Medicare/VA |
$369.93
|
Rate for Payer: One Health Plan of WY PPO |
$578.20
|
Rate for Payer: PacificSource Commercial |
$531.00
|
Rate for Payer: PHCS PPO |
$578.20
|
Rate for Payer: Three Rivers PPO |
$442.50
|
Rate for Payer: TriWest Veterans Administration |
$389.40
|
Rate for Payer: United Healthcare Commercial |
$513.30
|
Rate for Payer: United Healthcare Medicare |
$389.40
|
Rate for Payer: WINHealth Partners Commercial |
$560.50
|
Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
HC COMPATIBILITY TEST ANTIGLOB TECH
|
Facility
|
OP
|
$590.00
|
|
Service Code
|
HCPCS 86922
|
Hospital Charge Code |
3008692201
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$325.09 |
Max. Negotiated Rate |
$590.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
Rate for Payer: Aetna of WY Medicare |
$389.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
Rate for Payer: Altius Commercial |
$566.40
|
Rate for Payer: Beech Street Commercial |
$578.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
Rate for Payer: Cash Price |
$413.00
|
Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
Rate for Payer: Cigna of WY Commercial |
$578.20
|
Rate for Payer: Entrust Commercial |
$560.50
|
Rate for Payer: First Choice Health Commercial |
$560.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$342.20
|
Rate for Payer: HealthUtah PPO |
$590.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
Rate for Payer: Multiplan Medicare/VA |
$325.09
|
Rate for Payer: One Health Plan of WY PPO |
$578.20
|
Rate for Payer: PacificSource Commercial |
$531.00
|
Rate for Payer: PHCS PPO |
$578.20
|
Rate for Payer: Three Rivers PPO |
$442.50
|
Rate for Payer: TriWest Veterans Administration |
$342.20
|
Rate for Payer: United Healthcare Commercial |
$513.30
|
Rate for Payer: United Healthcare Medicare |
$342.20
|
Rate for Payer: WINHealth Partners Commercial |
$578.20
|
Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
HC COMPLEMENT;ANITGEN EA
|
Facility
|
OP
|
$183.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616008
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$100.83 |
Max. Negotiated Rate |
$183.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
Rate for Payer: Aetna of WY Medicare |
$120.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
Rate for Payer: Altius Commercial |
$175.68
|
Rate for Payer: Beech Street Commercial |
$179.34
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
Rate for Payer: Cash Price |
$128.10
|
Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
Rate for Payer: Cigna of WY Commercial |
$179.34
|
Rate for Payer: Entrust Commercial |
$173.85
|
Rate for Payer: First Choice Health Commercial |
$173.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
Rate for Payer: HealthUtah PPO |
$183.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
Rate for Payer: Multiplan Medicare/VA |
$100.83
|
Rate for Payer: One Health Plan of WY PPO |
$179.34
|
Rate for Payer: PacificSource Commercial |
$164.70
|
Rate for Payer: PHCS PPO |
$179.34
|
Rate for Payer: Three Rivers PPO |
$137.25
|
Rate for Payer: TriWest Veterans Administration |
$106.14
|
Rate for Payer: United Healthcare Commercial |
$159.21
|
Rate for Payer: United Healthcare Medicare |
$106.14
|
Rate for Payer: WINHealth Partners Commercial |
$179.34
|
Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
HC COMPLEMENT;ANITGEN EA
|
Facility
|
IP
|
$183.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616008
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$114.74 |
Max. Negotiated Rate |
$183.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
Rate for Payer: Altius Commercial |
$175.68
|
Rate for Payer: Beech Street Commercial |
$179.34
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
Rate for Payer: Cash Price |
$128.10
|
Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
Rate for Payer: Cigna of WY Commercial |
$179.34
|
Rate for Payer: Entrust Commercial |
$173.85
|
Rate for Payer: First Choice Health Commercial |
$173.85
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.78
|
Rate for Payer: HealthUtah PPO |
$183.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
Rate for Payer: Multiplan Medicare/VA |
$114.74
|
Rate for Payer: One Health Plan of WY PPO |
$179.34
|
Rate for Payer: PacificSource Commercial |
$164.70
|
Rate for Payer: PHCS PPO |
$179.34
|
Rate for Payer: Three Rivers PPO |
$137.25
|
Rate for Payer: TriWest Veterans Administration |
$120.78
|
Rate for Payer: United Healthcare Commercial |
$159.21
|
Rate for Payer: United Healthcare Medicare |
$120.78
|
Rate for Payer: WINHealth Partners Commercial |
$173.85
|
Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
HC COMPLEMENT, ANTIGEN - C2 COMPLEMENT
|
Facility
|
OP
|
$110.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616003
|
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 COMPLEMENT, ANTIGEN - C2 COMPLEMENT
|
Facility
|
IP
|
$110.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616003
|
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 COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$180.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616002
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$99.18 |
Max. Negotiated Rate |
$180.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
Rate for Payer: Aetna of WY Medicare |
$118.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
Rate for Payer: Altius Commercial |
$172.80
|
Rate for Payer: Beech Street Commercial |
$176.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
Rate for Payer: Cigna of WY Commercial |
$176.40
|
Rate for Payer: Entrust Commercial |
$171.00
|
Rate for Payer: First Choice Health Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
Rate for Payer: HealthUtah PPO |
$180.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
Rate for Payer: Multiplan Medicare/VA |
$99.18
|
Rate for Payer: One Health Plan of WY PPO |
$176.40
|
Rate for Payer: PacificSource Commercial |
$162.00
|
Rate for Payer: PHCS PPO |
$176.40
|
Rate for Payer: Three Rivers PPO |
$135.00
|
Rate for Payer: TriWest Veterans Administration |
$104.40
|
Rate for Payer: United Healthcare Commercial |
$156.60
|
Rate for Payer: United Healthcare Medicare |
$104.40
|
Rate for Payer: WINHealth Partners Commercial |
$176.40
|
Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$180.00
|
|
Service Code
|
HCPCS 86160
|
Hospital Charge Code |
3028616002
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$112.86 |
Max. Negotiated Rate |
$180.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
Rate for Payer: Altius Commercial |
$172.80
|
Rate for Payer: Beech Street Commercial |
$176.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
Rate for Payer: Cigna of WY Commercial |
$176.40
|
Rate for Payer: Entrust Commercial |
$171.00
|
Rate for Payer: First Choice Health Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
Rate for Payer: HealthUtah PPO |
$180.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
Rate for Payer: Multiplan Medicare/VA |
$112.86
|
Rate for Payer: One Health Plan of WY PPO |
$176.40
|
Rate for Payer: PacificSource Commercial |
$162.00
|
Rate for Payer: PHCS PPO |
$176.40
|
Rate for Payer: Three Rivers PPO |
$135.00
|
Rate for Payer: TriWest Veterans Administration |
$118.80
|
Rate for Payer: United Healthcare Commercial |
$156.60
|
Rate for Payer: United Healthcare Medicare |
$118.80
|
Rate for Payer: WINHealth Partners Commercial |
$171.00
|
Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|