|
HC CYSTOSCOPY PROCEDURE
|
Facility
|
OP
|
$1,430.00
|
|
| Hospital Charge Code |
3600000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$943.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$787.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$829.40
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$829.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
7505200001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$771.21 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,205.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,180.80
|
| Rate for Payer: Altius Commercial |
$1,180.80
|
| Rate for Payer: Beech Street Commercial |
$1,205.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,009.83
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,193.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,205.40
|
| Rate for Payer: Entrust Commercial |
$1,168.50
|
| Rate for Payer: First Choice Health Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$811.80
|
| Rate for Payer: HealthUtah PPO |
$1,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,193.10
|
| Rate for Payer: Multiplan Medicare/VA |
$771.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,205.40
|
| Rate for Payer: PacificSource Commercial |
$1,107.00
|
| Rate for Payer: PHCS PPO |
$1,205.40
|
| Rate for Payer: Three Rivers PPO |
$922.50
|
| Rate for Payer: TriWest Veterans Administration |
$811.80
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Medicare |
$811.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,168.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,168.50
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
7505200001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$677.73 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,205.40
|
| Rate for Payer: Aetna of WY Medicare |
$811.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,180.80
|
| Rate for Payer: Altius Commercial |
$1,180.80
|
| Rate for Payer: Beech Street Commercial |
$1,205.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,009.83
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,193.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,205.40
|
| Rate for Payer: Entrust Commercial |
$1,168.50
|
| Rate for Payer: First Choice Health Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$713.40
|
| Rate for Payer: HealthUtah PPO |
$1,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,193.10
|
| Rate for Payer: Multiplan Medicare/VA |
$677.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1,205.40
|
| Rate for Payer: PacificSource Commercial |
$1,107.00
|
| Rate for Payer: PHCS PPO |
$1,205.40
|
| Rate for Payer: Three Rivers PPO |
$922.50
|
| Rate for Payer: TriWest Veterans Administration |
$713.40
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Medicare |
$713.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,205.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,168.50
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
3615200001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$959.31 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,499.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,468.80
|
| Rate for Payer: Altius Commercial |
$1,468.80
|
| Rate for Payer: Beech Street Commercial |
$1,499.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,256.13
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,484.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,499.40
|
| Rate for Payer: Entrust Commercial |
$1,453.50
|
| Rate for Payer: First Choice Health Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.80
|
| Rate for Payer: HealthUtah PPO |
$1,530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,484.10
|
| Rate for Payer: Multiplan Medicare/VA |
$959.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,499.40
|
| Rate for Payer: PacificSource Commercial |
$1,377.00
|
| Rate for Payer: PHCS PPO |
$1,499.40
|
| Rate for Payer: Three Rivers PPO |
$1,147.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.80
|
| Rate for Payer: United Healthcare Commercial |
$1,331.10
|
| Rate for Payer: United Healthcare Medicare |
$1,009.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,453.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,453.50
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
3615200001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.03 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,499.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,009.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,468.80
|
| Rate for Payer: Altius Commercial |
$1,468.80
|
| Rate for Payer: Beech Street Commercial |
$1,499.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,256.13
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,484.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,499.40
|
| Rate for Payer: Entrust Commercial |
$1,453.50
|
| Rate for Payer: First Choice Health Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,453.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$887.40
|
| Rate for Payer: HealthUtah PPO |
$1,530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,484.10
|
| Rate for Payer: Multiplan Medicare/VA |
$843.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,499.40
|
| Rate for Payer: PacificSource Commercial |
$1,377.00
|
| Rate for Payer: PHCS PPO |
$1,499.40
|
| Rate for Payer: Three Rivers PPO |
$1,147.50
|
| Rate for Payer: TriWest Veterans Administration |
$887.40
|
| Rate for Payer: United Healthcare Commercial |
$1,331.10
|
| Rate for Payer: United Healthcare Medicare |
$887.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,499.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,453.50
|
|
|
HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
3108122901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6,473.78 |
| Max. Negotiated Rate |
$10,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,118.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,912.00
|
| Rate for Payer: Altius Commercial |
$9,912.00
|
| Rate for Payer: Beech Street Commercial |
$10,118.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,476.82
|
| Rate for Payer: Cash Price |
$7,227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,015.25
|
| Rate for Payer: Cigna of WY Commercial |
$10,118.50
|
| Rate for Payer: Entrust Commercial |
$9,808.75
|
| Rate for Payer: First Choice Health Commercial |
$9,808.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,808.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,814.50
|
| Rate for Payer: HealthUtah PPO |
$10,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,015.25
|
| Rate for Payer: Multiplan Medicare/VA |
$6,473.78
|
| Rate for Payer: One Health Plan of WY PPO |
$10,118.50
|
| Rate for Payer: PacificSource Commercial |
$9,292.50
|
| Rate for Payer: PHCS PPO |
$10,118.50
|
| Rate for Payer: Three Rivers PPO |
$7,743.75
|
| Rate for Payer: TriWest Veterans Administration |
$6,814.50
|
| Rate for Payer: United Healthcare Commercial |
$8,982.75
|
| Rate for Payer: United Healthcare Medicare |
$6,814.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,808.75
|
| Rate for Payer: Wise Provider Network Commercial |
$9,808.75
|
|
|
HC CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
HCPCS 81229
|
| Hospital Charge Code |
3108122901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5,689.08 |
| Max. Negotiated Rate |
$10,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,118.50
|
| Rate for Payer: Aetna of WY Medicare |
$6,814.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,912.00
|
| Rate for Payer: Altius Commercial |
$9,912.00
|
| Rate for Payer: Beech Street Commercial |
$10,118.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,476.82
|
| Rate for Payer: Cash Price |
$7,227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,015.25
|
| Rate for Payer: Cigna of WY Commercial |
$10,118.50
|
| Rate for Payer: Entrust Commercial |
$9,808.75
|
| Rate for Payer: First Choice Health Commercial |
$9,808.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,808.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,988.50
|
| Rate for Payer: HealthUtah PPO |
$10,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,015.25
|
| Rate for Payer: Multiplan Medicare/VA |
$5,689.08
|
| Rate for Payer: One Health Plan of WY PPO |
$10,118.50
|
| Rate for Payer: PacificSource Commercial |
$9,292.50
|
| Rate for Payer: PHCS PPO |
$10,118.50
|
| Rate for Payer: Three Rivers PPO |
$7,743.75
|
| Rate for Payer: TriWest Veterans Administration |
$5,988.50
|
| Rate for Payer: United Healthcare Commercial |
$8,982.75
|
| Rate for Payer: United Healthcare Medicare |
$5,988.50
|
| Rate for Payer: WINHealth Partners Commercial |
$10,118.50
|
| Rate for Payer: Wise Provider Network Commercial |
$9,808.75
|
|
|
HC CYTOGENETIC INTERPRETATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
3108829101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC CYTOGENETIC INTERPRETATION
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
3108829101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
3108827501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Medicare |
$376.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.60
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$314.07
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$330.60
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$330.60
|
| Rate for Payer: WINHealth Partners Commercial |
$558.60
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
3108827501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.20
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$357.39
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$376.20
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$376.20
|
| Rate for Payer: WINHealth Partners Commercial |
$541.50
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC CYTOLOGIC EXAMINATION
|
Facility
|
OP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
3118833301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2,347.26 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,174.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,811.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,089.60
|
| Rate for Payer: Altius Commercial |
$4,089.60
|
| Rate for Payer: Beech Street Commercial |
$4,174.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,497.46
|
| Rate for Payer: Cash Price |
$2,982.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,132.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,174.80
|
| Rate for Payer: Entrust Commercial |
$4,047.00
|
| Rate for Payer: First Choice Health Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,470.80
|
| Rate for Payer: HealthUtah PPO |
$4,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,132.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,347.26
|
| Rate for Payer: One Health Plan of WY PPO |
$4,174.80
|
| Rate for Payer: PacificSource Commercial |
$3,834.00
|
| Rate for Payer: PHCS PPO |
$4,174.80
|
| Rate for Payer: Three Rivers PPO |
$3,195.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,470.80
|
| Rate for Payer: United Healthcare Commercial |
$3,706.20
|
| Rate for Payer: United Healthcare Medicare |
$2,470.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,174.80
|
| Rate for Payer: Wise Provider Network Commercial |
$4,047.00
|
|
|
HC CYTOLOGIC EXAMINATION
|
Facility
|
IP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
3118833301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2,671.02 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,174.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,089.60
|
| Rate for Payer: Altius Commercial |
$4,089.60
|
| Rate for Payer: Beech Street Commercial |
$4,174.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,497.46
|
| Rate for Payer: Cash Price |
$2,982.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,132.20
|
| Rate for Payer: Cigna of WY Commercial |
$4,174.80
|
| Rate for Payer: Entrust Commercial |
$4,047.00
|
| Rate for Payer: First Choice Health Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,047.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,811.60
|
| Rate for Payer: HealthUtah PPO |
$4,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,132.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,671.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,174.80
|
| Rate for Payer: PacificSource Commercial |
$3,834.00
|
| Rate for Payer: PHCS PPO |
$4,174.80
|
| Rate for Payer: Three Rivers PPO |
$3,195.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,811.60
|
| Rate for Payer: United Healthcare Commercial |
$3,706.20
|
| Rate for Payer: United Healthcare Medicare |
$2,811.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,047.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,047.00
|
|
|
HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3068749601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Aetna of WY Medicare |
$726.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$606.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,078.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
3068749601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$689.70 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$726.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$689.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
3068749701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
3068749701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
3118810801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 88108
|
| Hospital Charge Code |
3118810801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
3118817301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.30
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$191.24
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$201.30
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
3118817301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$201.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.90
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$168.06
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$176.90
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$176.90
|
| Rate for Payer: WINHealth Partners Commercial |
$298.90
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC CYTOPATH FL NONGYN SMEARS - LAB CYTOPATH FLUIDS,SMEAR,INTERP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
3118810401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CYTOPATH FL NONGYN SMEARS - LAB CYTOPATH FLUIDS,SMEAR,INTERP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
3118810401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,PREP,SCRN,INT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,PREP,SCRN,INT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
