|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
3018237401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| 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 ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 82373
|
| Hospital Charge Code |
3018237301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 82373
|
| Hospital Charge Code |
3018237301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Aetna of WY Medicare |
$283.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.40
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$236.93
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.40
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$249.40
|
| Rate for Payer: WINHealth Partners Commercial |
$421.40
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$269.61 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$283.80
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$269.61
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$283.80
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$283.80
|
| Rate for Payer: WINHealth Partners Commercial |
$408.50
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC ASSAY EVEROLIMUS
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$359.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.10
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$300.30
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$316.10
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$316.10
|
| Rate for Payer: WINHealth Partners Commercial |
$534.10
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC ASSAY EVEROLIMUS
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$341.72 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.70
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$341.72
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$359.70
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
| Rate for Payer: WINHealth Partners Commercial |
$517.75
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, URINE
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$113.28
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.88
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.88
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$73.99
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$77.88
|
| Rate for Payer: United Healthcare Commercial |
$102.66
|
| Rate for Payer: United Healthcare Medicare |
$77.88
|
| Rate for Payer: WINHealth Partners Commercial |
$112.10
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, URINE
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Aetna of WY Medicare |
$77.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$113.28
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.88
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.44
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$65.02
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$68.44
|
| Rate for Payer: United Healthcare Commercial |
$102.66
|
| Rate for Payer: United Healthcare Medicare |
$68.44
|
| Rate for Payer: WINHealth Partners Commercial |
$115.64
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - POCT COLLAGEN TYPE I CROSSLINK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - POCT COLLAGEN TYPE I CROSSLINK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE BODY FLUID
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE BODY FLUID
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3018300301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3018300301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC ASSAY INFLUENZA A BY PCR
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$288.42 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.60
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$288.42
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.60
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$303.60
|
| Rate for Payer: WINHealth Partners Commercial |
$437.00
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
|
HC ASSAY INFLUENZA A BY PCR
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$253.46 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$303.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.80
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$253.46
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$266.80
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$266.80
|
| Rate for Payer: WINHealth Partners Commercial |
$450.80
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
|
HC ASSAY INFLUENZA B BY PCR
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$288.42 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.60
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$288.42
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.60
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$303.60
|
| Rate for Payer: WINHealth Partners Commercial |
$437.00
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
|
HC ASSAY INFLUENZA B BY PCR
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$253.46 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$303.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.80
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$253.46
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$266.80
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$266.80
|
| Rate for Payer: WINHealth Partners Commercial |
$450.80
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
