|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616001
|
|
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 - C4 COMPLEMENT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616001
|
|
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
|
|
|
HC COMPLEMENT, ANTIGEN - C5 COMPLEMENT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616004
|
|
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 - C5 COMPLEMENT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616004
|
|
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 - C6 COMPLEMENT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616005
|
|
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 - C6 COMPLEMENT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616005
|
|
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 -COMPLEMENT COMPONENT C1Q
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Aetna of WY Medicare |
$117.12
|
| 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 |
$177.51
|
| 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 |
$111.63
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$106.05
|
| 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 |
$111.63
|
| Rate for Payer: United Healthcare Commercial |
$174.76
|
| Rate for Payer: United Healthcare Medicare |
$111.63
|
| Rate for Payer: WINHealth Partners Commercial |
$173.85
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC COMPLEMENT, ANTIGEN -COMPLEMENT COMPONENT C1Q
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.09 |
| 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 Commercial |
$175.68
|
| Rate for Payer: Beech Street Commercial |
$179.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.51
|
| 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 |
$104.31
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$99.09
|
| 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 |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$174.76
|
| Rate for Payer: United Healthcare Medicare |
$104.31
|
| Rate for Payer: WINHealth Partners Commercial |
$179.34
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR, FUNCTIONAL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.20
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$46.36
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.80
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$48.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR, FUNCTIONAL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.60
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.32
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR PANEL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR PANEL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.08
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.42
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$70.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$74.42
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$169.21 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$286.16
|
| Rate for Payer: Aetna of WY Medicare |
$186.88
|
| Rate for Payer: Altius Commercial |
$280.32
|
| Rate for Payer: Beech Street Commercial |
$286.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$204.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$283.24
|
| Rate for Payer: Cigna of WY Commercial |
$286.16
|
| Rate for Payer: Entrust Commercial |
$277.40
|
| Rate for Payer: First Choice Health Commercial |
$277.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$277.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.12
|
| Rate for Payer: HealthUtah PPO |
$292.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$283.24
|
| Rate for Payer: Multiplan Medicare/VA |
$169.21
|
| Rate for Payer: One Health Plan of WY PPO |
$286.16
|
| Rate for Payer: PacificSource Commercial |
$262.80
|
| Rate for Payer: PHCS PPO |
$286.16
|
| Rate for Payer: Three Rivers PPO |
$219.00
|
| Rate for Payer: TriWest Veterans Administration |
$178.12
|
| Rate for Payer: United Healthcare Commercial |
$278.86
|
| Rate for Payer: United Healthcare Medicare |
$178.12
|
| Rate for Payer: WINHealth Partners Commercial |
$277.40
|
| Rate for Payer: Wise Provider Network Commercial |
$277.40
|
|
|
HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$286.16
|
| Rate for Payer: Aetna of WY Medicare |
$192.72
|
| Rate for Payer: Altius Commercial |
$280.32
|
| Rate for Payer: Beech Street Commercial |
$286.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$283.24
|
| Rate for Payer: Cash Price |
$204.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$283.24
|
| Rate for Payer: Cigna of WY Commercial |
$286.16
|
| Rate for Payer: Entrust Commercial |
$277.40
|
| Rate for Payer: First Choice Health Commercial |
$277.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$277.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.44
|
| Rate for Payer: HealthUtah PPO |
$292.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$283.24
|
| Rate for Payer: Multiplan Medicare/VA |
$158.12
|
| Rate for Payer: One Health Plan of WY PPO |
$286.16
|
| Rate for Payer: PacificSource Commercial |
$262.80
|
| Rate for Payer: PHCS PPO |
$286.16
|
| Rate for Payer: Three Rivers PPO |
$219.00
|
| Rate for Payer: TriWest Veterans Administration |
$166.44
|
| Rate for Payer: United Healthcare Commercial |
$278.86
|
| Rate for Payer: United Healthcare Medicare |
$166.44
|
| Rate for Payer: WINHealth Partners Commercial |
$286.16
|
| Rate for Payer: Wise Provider Network Commercial |
$277.40
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Medicare |
$51.48
|
| Rate for Payer: Altius Commercial |
$74.88
|
| Rate for Payer: Beech Street Commercial |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.66
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: Entrust Commercial |
$74.10
|
| Rate for Payer: First Choice Health Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.46
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Multiplan Medicare/VA |
$42.24
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$76.44
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: TriWest Veterans Administration |
$44.46
|
| Rate for Payer: United Healthcare Commercial |
$74.49
|
| Rate for Payer: United Healthcare Medicare |
$44.46
|
| Rate for Payer: WINHealth Partners Commercial |
$76.44
|
| Rate for Payer: Wise Provider Network Commercial |
$74.10
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Medicare |
$49.92
|
| Rate for Payer: Altius Commercial |
$74.88
|
| Rate for Payer: Beech Street Commercial |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$75.66
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: Entrust Commercial |
$74.10
|
| Rate for Payer: First Choice Health Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.58
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Multiplan Medicare/VA |
$45.20
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$76.44
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.58
|
| Rate for Payer: United Healthcare Commercial |
$74.49
|
| Rate for Payer: United Healthcare Medicare |
$47.58
|
| Rate for Payer: WINHealth Partners Commercial |
$74.10
|
| Rate for Payer: Wise Provider Network Commercial |
$74.10
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.00
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.25
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$14.49
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$15.25
|
| Rate for Payer: United Healthcare Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare |
$15.25
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Aetna of WY Medicare |
$16.50
|
| Rate for Payer: Altius Commercial |
$24.00
|
| Rate for Payer: Beech Street Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.25
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: Entrust Commercial |
$23.75
|
| Rate for Payer: First Choice Health Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.25
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: Multiplan Medicare/VA |
$13.54
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$24.50
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: TriWest Veterans Administration |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare |
$14.25
|
| Rate for Payer: WINHealth Partners Commercial |
$24.50
|
| Rate for Payer: Wise Provider Network Commercial |
$23.75
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.84 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$485.76
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$736.23
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.99
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$439.84
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$462.99
|
| Rate for Payer: United Healthcare Commercial |
$724.84
|
| Rate for Payer: United Healthcare Medicare |
$462.99
|
| Rate for Payer: WINHealth Partners Commercial |
$721.05
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.00 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$743.82
|
| Rate for Payer: Aetna of WY Medicare |
$500.94
|
| Rate for Payer: Altius Commercial |
$728.64
|
| Rate for Payer: Beech Street Commercial |
$743.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$736.23
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$736.23
|
| Rate for Payer: Cigna of WY Commercial |
$743.82
|
| Rate for Payer: Entrust Commercial |
$721.05
|
| Rate for Payer: First Choice Health Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$721.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.63
|
| Rate for Payer: HealthUtah PPO |
$759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$736.23
|
| Rate for Payer: Multiplan Medicare/VA |
$411.00
|
| Rate for Payer: One Health Plan of WY PPO |
$743.82
|
| Rate for Payer: PacificSource Commercial |
$683.10
|
| Rate for Payer: PHCS PPO |
$743.82
|
| Rate for Payer: Three Rivers PPO |
$569.25
|
| Rate for Payer: TriWest Veterans Administration |
$432.63
|
| Rate for Payer: United Healthcare Commercial |
$724.84
|
| Rate for Payer: United Healthcare Medicare |
$432.63
|
| Rate for Payer: WINHealth Partners Commercial |
$743.82
|
| Rate for Payer: Wise Provider Network Commercial |
$721.05
|
|
|
HC COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 51729
|
| Hospital Charge Code |
5105172901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$177.54
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.33
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$145.66
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.33
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$153.33
|
| Rate for Payer: WINHealth Partners Commercial |
$263.62
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 51729
|
| Hospital Charge Code |
5105172901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$172.16
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.09
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$155.89
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$164.09
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$164.09
|
| Rate for Payer: WINHealth Partners Commercial |
$255.55
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC COMPRESSION STOCKINGS FULL LENGTH/CHAPS STYLE 40-50 MMHG EACH
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS A6538
|
| Hospital Charge Code |
420A653801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$390.58 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Medicare |
$431.36
|
| Rate for Payer: Altius Commercial |
$647.04
|
| Rate for Payer: Beech Street Commercial |
$660.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$653.78
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: Entrust Commercial |
$640.30
|
| Rate for Payer: First Choice Health Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.14
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Multiplan Medicare/VA |
$390.58
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$660.52
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: TriWest Veterans Administration |
$411.14
|
| Rate for Payer: United Healthcare Commercial |
$643.67
|
| Rate for Payer: United Healthcare Medicare |
$411.14
|
| Rate for Payer: WINHealth Partners Commercial |
$640.30
|
| Rate for Payer: Wise Provider Network Commercial |
$640.30
|
|
|
HC COMPRESSION STOCKINGS FULL LENGTH/CHAPS STYLE 40-50 MMHG EACH
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS A6538
|
| Hospital Charge Code |
420A653801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$364.97 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$660.52
|
| Rate for Payer: Aetna of WY Medicare |
$444.84
|
| Rate for Payer: Altius Commercial |
$647.04
|
| Rate for Payer: Beech Street Commercial |
$660.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$653.78
|
| Rate for Payer: Cash Price |
$471.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$653.78
|
| Rate for Payer: Cigna of WY Commercial |
$660.52
|
| Rate for Payer: Entrust Commercial |
$640.30
|
| Rate for Payer: First Choice Health Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$640.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.18
|
| Rate for Payer: HealthUtah PPO |
$674.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$653.78
|
| Rate for Payer: Multiplan Medicare/VA |
$364.97
|
| Rate for Payer: One Health Plan of WY PPO |
$660.52
|
| Rate for Payer: PacificSource Commercial |
$606.60
|
| Rate for Payer: PHCS PPO |
$660.52
|
| Rate for Payer: Three Rivers PPO |
$505.50
|
| Rate for Payer: TriWest Veterans Administration |
$384.18
|
| Rate for Payer: United Healthcare Commercial |
$643.67
|
| Rate for Payer: United Healthcare Medicare |
$384.18
|
| Rate for Payer: WINHealth Partners Commercial |
$660.52
|
| Rate for Payer: Wise Provider Network Commercial |
$640.30
|
|
|
HC CONTROL THROAT BLEED,SIMPLE
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
7614296001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
