|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$122.24
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$185.27
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.51
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$110.68
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$116.51
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
| Rate for Payer: United Healthcare Medicare |
$116.51
|
| Rate for Payer: WINHealth Partners Commercial |
$181.45
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - COENZYME Q10
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$139.52
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.46
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.98
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$126.33
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$132.98
|
| Rate for Payer: United Healthcare Commercial |
$208.19
|
| Rate for Payer: United Healthcare Medicare |
$132.98
|
| Rate for Payer: WINHealth Partners Commercial |
$207.10
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - COENZYME Q10
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.05 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$143.88
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.46
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.26
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$118.05
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$124.26
|
| Rate for Payer: United Healthcare Commercial |
$208.19
|
| Rate for Payer: United Healthcare Medicare |
$124.26
|
| Rate for Payer: WINHealth Partners Commercial |
$213.64
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - MDMA ECSTASY UR
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$139.52
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.46
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.98
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$126.33
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$132.98
|
| Rate for Payer: United Healthcare Commercial |
$208.19
|
| Rate for Payer: United Healthcare Medicare |
$132.98
|
| Rate for Payer: WINHealth Partners Commercial |
$207.10
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - MDMA ECSTASY UR
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.05 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$143.88
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.46
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.26
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$118.05
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$124.26
|
| Rate for Payer: United Healthcare Commercial |
$208.19
|
| Rate for Payer: United Healthcare Medicare |
$124.26
|
| Rate for Payer: WINHealth Partners Commercial |
$213.64
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - TETRAHYDROALDOSTERON
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$177.07 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$320.46
|
| Rate for Payer: Aetna of WY Medicare |
$215.82
|
| Rate for Payer: Altius Commercial |
$313.92
|
| Rate for Payer: Beech Street Commercial |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$317.19
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$317.19
|
| Rate for Payer: Cigna of WY Commercial |
$320.46
|
| Rate for Payer: Entrust Commercial |
$310.65
|
| Rate for Payer: First Choice Health Commercial |
$310.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$310.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.39
|
| Rate for Payer: HealthUtah PPO |
$327.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$317.19
|
| Rate for Payer: Multiplan Medicare/VA |
$177.07
|
| Rate for Payer: One Health Plan of WY PPO |
$320.46
|
| Rate for Payer: PacificSource Commercial |
$294.30
|
| Rate for Payer: PHCS PPO |
$320.46
|
| Rate for Payer: Three Rivers PPO |
$245.25
|
| Rate for Payer: TriWest Veterans Administration |
$186.39
|
| Rate for Payer: United Healthcare Commercial |
$312.28
|
| Rate for Payer: United Healthcare Medicare |
$186.39
|
| Rate for Payer: WINHealth Partners Commercial |
$320.46
|
| Rate for Payer: Wise Provider Network Commercial |
$310.65
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - TETRAHYDROALDOSTERON
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.50 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$320.46
|
| Rate for Payer: Aetna of WY Medicare |
$209.28
|
| Rate for Payer: Altius Commercial |
$313.92
|
| Rate for Payer: Beech Street Commercial |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$317.19
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$317.19
|
| Rate for Payer: Cigna of WY Commercial |
$320.46
|
| Rate for Payer: Entrust Commercial |
$310.65
|
| Rate for Payer: First Choice Health Commercial |
$310.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$310.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.47
|
| Rate for Payer: HealthUtah PPO |
$327.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$317.19
|
| Rate for Payer: Multiplan Medicare/VA |
$189.50
|
| Rate for Payer: One Health Plan of WY PPO |
$320.46
|
| Rate for Payer: PacificSource Commercial |
$294.30
|
| Rate for Payer: PHCS PPO |
$320.46
|
| Rate for Payer: Three Rivers PPO |
$245.25
|
| Rate for Payer: TriWest Veterans Administration |
$199.47
|
| Rate for Payer: United Healthcare Commercial |
$312.28
|
| Rate for Payer: United Healthcare Medicare |
$199.47
|
| Rate for Payer: WINHealth Partners Commercial |
$310.65
|
| Rate for Payer: Wise Provider Network Commercial |
$310.65
|
|
|
HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
3028615701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.48 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$71.28
|
| Rate for Payer: Altius Commercial |
$103.68
|
| Rate for Payer: Beech Street Commercial |
$105.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.76
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: Entrust Commercial |
$102.60
|
| Rate for Payer: First Choice Health Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.56
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$58.48
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$105.84
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$61.56
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
| Rate for Payer: United Healthcare Medicare |
$61.56
|
| Rate for Payer: WINHealth Partners Commercial |
$105.84
|
| Rate for Payer: Wise Provider Network Commercial |
$102.60
|
|
|
HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
3028615701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.59 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$69.12
|
| Rate for Payer: Altius Commercial |
$103.68
|
| Rate for Payer: Beech Street Commercial |
$105.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.76
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: Entrust Commercial |
$102.60
|
| Rate for Payer: First Choice Health Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.88
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$62.59
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$105.84
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$65.88
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
| Rate for Payer: United Healthcare Medicare |
$65.88
|
| Rate for Payer: WINHealth Partners Commercial |
$102.60
|
| Rate for Payer: Wise Provider Network Commercial |
$102.60
|
|
|
HC COLONOSCOPE/EGD PROCEDURE
|
Facility
|
IP
|
$891.00
|
|
| Hospital Charge Code |
3600000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$516.33 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$873.18
|
| Rate for Payer: Aetna of WY Medicare |
$570.24
|
| Rate for Payer: Altius Commercial |
$855.36
|
| Rate for Payer: Beech Street Commercial |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$864.27
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$864.27
|
| Rate for Payer: Cigna of WY Commercial |
$873.18
|
| Rate for Payer: Entrust Commercial |
$846.45
|
| Rate for Payer: First Choice Health Commercial |
$846.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$846.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$543.51
|
| Rate for Payer: HealthUtah PPO |
$891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$864.27
|
| Rate for Payer: Multiplan Medicare/VA |
$516.33
|
| Rate for Payer: One Health Plan of WY PPO |
$873.18
|
| Rate for Payer: PacificSource Commercial |
$801.90
|
| Rate for Payer: PHCS PPO |
$873.18
|
| Rate for Payer: Three Rivers PPO |
$668.25
|
| Rate for Payer: TriWest Veterans Administration |
$543.51
|
| Rate for Payer: United Healthcare Commercial |
$850.90
|
| Rate for Payer: United Healthcare Medicare |
$543.51
|
| Rate for Payer: WINHealth Partners Commercial |
$846.45
|
| Rate for Payer: Wise Provider Network Commercial |
$846.45
|
|
|
HC COLONOSCOPE/EGD PROCEDURE
|
Facility
|
OP
|
$891.00
|
|
| Hospital Charge Code |
3600000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$482.48 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$873.18
|
| Rate for Payer: Aetna of WY Medicare |
$588.06
|
| Rate for Payer: Altius Commercial |
$855.36
|
| Rate for Payer: Beech Street Commercial |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$864.27
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$864.27
|
| Rate for Payer: Cigna of WY Commercial |
$873.18
|
| Rate for Payer: Entrust Commercial |
$846.45
|
| Rate for Payer: First Choice Health Commercial |
$846.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$846.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.87
|
| Rate for Payer: HealthUtah PPO |
$891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$864.27
|
| Rate for Payer: Multiplan Medicare/VA |
$482.48
|
| Rate for Payer: One Health Plan of WY PPO |
$873.18
|
| Rate for Payer: PacificSource Commercial |
$801.90
|
| Rate for Payer: PHCS PPO |
$873.18
|
| Rate for Payer: Three Rivers PPO |
$668.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.87
|
| Rate for Payer: United Healthcare Commercial |
$850.90
|
| Rate for Payer: United Healthcare Medicare |
$507.87
|
| Rate for Payer: WINHealth Partners Commercial |
$873.18
|
| Rate for Payer: Wise Provider Network Commercial |
$846.45
|
|
|
HC COLONOSCOPE PROCEDURE
|
Facility
|
IP
|
$467.00
|
|
| Hospital Charge Code |
3600000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.63 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.66
|
| Rate for Payer: Aetna of WY Medicare |
$298.88
|
| Rate for Payer: Altius Commercial |
$448.32
|
| Rate for Payer: Beech Street Commercial |
$457.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$452.99
|
| Rate for Payer: Cash Price |
$326.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.99
|
| Rate for Payer: Cigna of WY Commercial |
$457.66
|
| Rate for Payer: Entrust Commercial |
$443.65
|
| Rate for Payer: First Choice Health Commercial |
$443.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.87
|
| Rate for Payer: HealthUtah PPO |
$467.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.99
|
| Rate for Payer: Multiplan Medicare/VA |
$270.63
|
| Rate for Payer: One Health Plan of WY PPO |
$457.66
|
| Rate for Payer: PacificSource Commercial |
$420.30
|
| Rate for Payer: PHCS PPO |
$457.66
|
| Rate for Payer: Three Rivers PPO |
$350.25
|
| Rate for Payer: TriWest Veterans Administration |
$284.87
|
| Rate for Payer: United Healthcare Commercial |
$445.98
|
| Rate for Payer: United Healthcare Medicare |
$284.87
|
| Rate for Payer: WINHealth Partners Commercial |
$443.65
|
| Rate for Payer: Wise Provider Network Commercial |
$443.65
|
|
|
HC COLONOSCOPE PROCEDURE
|
Facility
|
OP
|
$467.00
|
|
| Hospital Charge Code |
3600000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.66
|
| Rate for Payer: Aetna of WY Medicare |
$308.22
|
| Rate for Payer: Altius Commercial |
$448.32
|
| Rate for Payer: Beech Street Commercial |
$457.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$452.99
|
| Rate for Payer: Cash Price |
$326.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.99
|
| Rate for Payer: Cigna of WY Commercial |
$457.66
|
| Rate for Payer: Entrust Commercial |
$443.65
|
| Rate for Payer: First Choice Health Commercial |
$443.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.19
|
| Rate for Payer: HealthUtah PPO |
$467.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.99
|
| Rate for Payer: Multiplan Medicare/VA |
$252.88
|
| Rate for Payer: One Health Plan of WY PPO |
$457.66
|
| Rate for Payer: PacificSource Commercial |
$420.30
|
| Rate for Payer: PHCS PPO |
$457.66
|
| Rate for Payer: Three Rivers PPO |
$350.25
|
| Rate for Payer: TriWest Veterans Administration |
$266.19
|
| Rate for Payer: United Healthcare Commercial |
$445.98
|
| Rate for Payer: United Healthcare Medicare |
$266.19
|
| Rate for Payer: WINHealth Partners Commercial |
$457.66
|
| Rate for Payer: Wise Provider Network Commercial |
$443.65
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$67.84
|
| Rate for Payer: Altius Commercial |
$101.76
|
| Rate for Payer: Beech Street Commercial |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: Entrust Commercial |
$100.70
|
| Rate for Payer: First Choice Health Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.66
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$61.43
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$103.88
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.66
|
| Rate for Payer: United Healthcare Commercial |
$101.23
|
| Rate for Payer: United Healthcare Medicare |
$64.66
|
| Rate for Payer: WINHealth Partners Commercial |
$100.70
|
| Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
5105745401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$69.96
|
| Rate for Payer: Altius Commercial |
$101.76
|
| Rate for Payer: Beech Street Commercial |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: Entrust Commercial |
$100.70
|
| Rate for Payer: First Choice Health Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.42
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$57.40
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$103.88
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.42
|
| Rate for Payer: United Healthcare Commercial |
$101.23
|
| Rate for Payer: United Healthcare Medicare |
$60.42
|
| Rate for Payer: WINHealth Partners Commercial |
$103.88
|
| Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
|
HC COLUMN CHROMATOGRAPHY NES - PRPHYRINS FRACTIONATED
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 85242
|
| Hospital Charge Code |
3058524201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$249.63 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$451.78
|
| Rate for Payer: Aetna of WY Medicare |
$304.26
|
| Rate for Payer: Altius Commercial |
$442.56
|
| Rate for Payer: Beech Street Commercial |
$451.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.17
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$447.17
|
| Rate for Payer: Cigna of WY Commercial |
$451.78
|
| Rate for Payer: Entrust Commercial |
$437.95
|
| Rate for Payer: First Choice Health Commercial |
$437.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.77
|
| Rate for Payer: HealthUtah PPO |
$461.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$447.17
|
| Rate for Payer: Multiplan Medicare/VA |
$249.63
|
| Rate for Payer: One Health Plan of WY PPO |
$451.78
|
| Rate for Payer: PacificSource Commercial |
$414.90
|
| Rate for Payer: PHCS PPO |
$451.78
|
| Rate for Payer: Three Rivers PPO |
$345.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.77
|
| Rate for Payer: United Healthcare Commercial |
$440.26
|
| Rate for Payer: United Healthcare Medicare |
$262.77
|
| Rate for Payer: WINHealth Partners Commercial |
$451.78
|
| Rate for Payer: Wise Provider Network Commercial |
$437.95
|
|
|
HC COLUMN CHROMATOGRAPHY NES - PRPHYRINS FRACTIONATED
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 85242
|
| Hospital Charge Code |
3058524201
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$267.15 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$451.78
|
| Rate for Payer: Aetna of WY Medicare |
$295.04
|
| Rate for Payer: Altius Commercial |
$442.56
|
| Rate for Payer: Beech Street Commercial |
$451.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.17
|
| Rate for Payer: Cash Price |
$322.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$447.17
|
| Rate for Payer: Cigna of WY Commercial |
$451.78
|
| Rate for Payer: Entrust Commercial |
$437.95
|
| Rate for Payer: First Choice Health Commercial |
$437.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.21
|
| Rate for Payer: HealthUtah PPO |
$461.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$447.17
|
| Rate for Payer: Multiplan Medicare/VA |
$267.15
|
| Rate for Payer: One Health Plan of WY PPO |
$451.78
|
| Rate for Payer: PacificSource Commercial |
$414.90
|
| Rate for Payer: PHCS PPO |
$451.78
|
| Rate for Payer: Three Rivers PPO |
$345.75
|
| Rate for Payer: TriWest Veterans Administration |
$281.21
|
| Rate for Payer: United Healthcare Commercial |
$440.26
|
| Rate for Payer: United Healthcare Medicare |
$281.21
|
| Rate for Payer: WINHealth Partners Commercial |
$437.95
|
| Rate for Payer: Wise Provider Network Commercial |
$437.95
|
|
|
HC COMPATIBILITY EACH UNIT ELECTRONIC
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
3008692301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.97 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Medicare |
$325.76
|
| Rate for Payer: Altius Commercial |
$488.64
|
| Rate for Payer: Beech Street Commercial |
$498.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$493.73
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: Entrust Commercial |
$483.55
|
| Rate for Payer: First Choice Health Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.49
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Multiplan Medicare/VA |
$294.97
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$498.82
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: TriWest Veterans Administration |
$310.49
|
| Rate for Payer: United Healthcare Commercial |
$486.10
|
| Rate for Payer: United Healthcare Medicare |
$310.49
|
| Rate for Payer: WINHealth Partners Commercial |
$483.55
|
| Rate for Payer: Wise Provider Network Commercial |
$483.55
|
|
|
HC COMPATIBILITY EACH UNIT ELECTRONIC
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
3008692301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.62 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: United Healthcare Commercial |
$486.10
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Medicare |
$335.94
|
| Rate for Payer: Altius Commercial |
$488.64
|
| Rate for Payer: Beech Street Commercial |
$498.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$493.73
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: Entrust Commercial |
$483.55
|
| Rate for Payer: First Choice Health Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.13
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Multiplan Medicare/VA |
$275.62
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$498.82
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: TriWest Veterans Administration |
$290.13
|
| Rate for Payer: United Healthcare Medicare |
$290.13
|
| Rate for Payer: WINHealth Partners Commercial |
$498.82
|
| Rate for Payer: Wise Provider Network Commercial |
$483.55
|
|
|
HC COMPATIBILITY TEST ANTIGLOB TECH
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$308.66 |
| 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 Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$552.90
|
| 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 |
$324.90
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$308.66
|
| 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 |
$324.90
|
| Rate for Payer: United Healthcare Commercial |
$544.35
|
| Rate for Payer: United Healthcare Medicare |
$324.90
|
| Rate for Payer: WINHealth Partners Commercial |
$558.60
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC COMPATIBILITY TEST ANTIGLOB TECH
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$330.32 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Medicare |
$364.80
|
| 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 |
$552.90
|
| 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 |
$347.70
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$330.32
|
| 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 |
$347.70
|
| Rate for Payer: United Healthcare Commercial |
$544.35
|
| Rate for Payer: United Healthcare Medicare |
$347.70
|
| Rate for Payer: WINHealth Partners Commercial |
$541.50
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC COMPLEMENT, ANTIGEN - C2 COMPLEMENT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$67.20
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$60.85
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC COMPLEMENT, ANTIGEN - C2 COMPLEMENT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.85
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$56.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$59.85
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$94.76
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$99.75
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$112.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$101.41
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
