|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
3018246502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$34.98
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.21
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$28.70
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$30.21
|
| Rate for Payer: United Healthcare Commercial |
$50.62
|
| Rate for Payer: United Healthcare Medicare |
$30.21
|
| Rate for Payer: WINHealth Partners Commercial |
$51.94
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
3018246502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.94
|
| Rate for Payer: Aetna of WY Medicare |
$33.92
|
| Rate for Payer: Altius Commercial |
$50.88
|
| Rate for Payer: Beech Street Commercial |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.41
|
| Rate for Payer: Cash Price |
$37.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.41
|
| Rate for Payer: Cigna of WY Commercial |
$51.94
|
| Rate for Payer: Entrust Commercial |
$50.35
|
| Rate for Payer: First Choice Health Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.33
|
| Rate for Payer: HealthUtah PPO |
$53.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.41
|
| Rate for Payer: Multiplan Medicare/VA |
$30.71
|
| Rate for Payer: One Health Plan of WY PPO |
$51.94
|
| Rate for Payer: PacificSource Commercial |
$47.70
|
| Rate for Payer: PHCS PPO |
$51.94
|
| Rate for Payer: Three Rivers PPO |
$39.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.33
|
| Rate for Payer: United Healthcare Commercial |
$50.62
|
| Rate for Payer: United Healthcare Medicare |
$32.33
|
| Rate for Payer: WINHealth Partners Commercial |
$50.35
|
| Rate for Payer: Wise Provider Network Commercial |
$50.35
|
|
|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
3018237401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$29.44
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.06
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$26.66
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$28.06
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$28.06
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC ASSAY BLOOD CARBON DIOXIDE - CO2 TOTAL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
3018237401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$30.36
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.22
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$24.91
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.22
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$26.22
|
| Rate for Payer: WINHealth Partners Commercial |
$45.08
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Aetna of WY Medicare |
$182.16
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.72
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.32
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$149.45
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$157.32
|
| Rate for Payer: United Healthcare Commercial |
$263.58
|
| Rate for Payer: United Healthcare Medicare |
$157.32
|
| Rate for Payer: WINHealth Partners Commercial |
$270.48
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC ASSAY, BLOOD CATECHOLAMINES - CATECHOLAMINES, TOTAL
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 82383
|
| Hospital Charge Code |
3018238301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.94 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Aetna of WY Medicare |
$176.64
|
| Rate for Payer: Altius Commercial |
$264.96
|
| Rate for Payer: Beech Street Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.72
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: Entrust Commercial |
$262.20
|
| Rate for Payer: First Choice Health Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.36
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$159.94
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$270.48
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$168.36
|
| Rate for Payer: United Healthcare Commercial |
$263.58
|
| Rate for Payer: United Healthcare Medicare |
$168.36
|
| Rate for Payer: WINHealth Partners Commercial |
$262.20
|
| Rate for Payer: Wise Provider Network Commercial |
$262.20
|
|
|
HC ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 82373
|
| Hospital Charge Code |
3018237301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.92
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$84.47
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.92
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$88.92
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 82373
|
| Hospital Charge Code |
3018237301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$99.84
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.16
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$90.40
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.16
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$95.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$174.72
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.53
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$158.20
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.53
|
| Rate for Payer: United Healthcare Medicare |
$166.53
|
| Rate for Payer: WINHealth Partners Commercial |
$259.35
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$180.18
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$264.81
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.61
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$147.83
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$155.61
|
| Rate for Payer: United Healthcare Commercial |
$260.72
|
| Rate for Payer: United Healthcare Medicare |
$155.61
|
| Rate for Payer: WINHealth Partners Commercial |
$267.54
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC ASSAY EVEROLIMUS
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$516.46
|
| Rate for Payer: Aetna of WY Medicare |
$337.28
|
| Rate for Payer: Altius Commercial |
$505.92
|
| Rate for Payer: Beech Street Commercial |
$516.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$511.19
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$511.19
|
| Rate for Payer: Cigna of WY Commercial |
$516.46
|
| Rate for Payer: Entrust Commercial |
$500.65
|
| Rate for Payer: First Choice Health Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.47
|
| Rate for Payer: HealthUtah PPO |
$527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$511.19
|
| Rate for Payer: Multiplan Medicare/VA |
$305.40
|
| Rate for Payer: One Health Plan of WY PPO |
$516.46
|
| Rate for Payer: PacificSource Commercial |
$474.30
|
| Rate for Payer: PHCS PPO |
$516.46
|
| Rate for Payer: Three Rivers PPO |
$395.25
|
| Rate for Payer: TriWest Veterans Administration |
$321.47
|
| Rate for Payer: United Healthcare Commercial |
$503.28
|
| Rate for Payer: United Healthcare Medicare |
$321.47
|
| Rate for Payer: WINHealth Partners Commercial |
$500.65
|
| Rate for Payer: Wise Provider Network Commercial |
$500.65
|
|
|
HC ASSAY EVEROLIMUS
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
3018016901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$285.37 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$516.46
|
| Rate for Payer: Aetna of WY Medicare |
$347.82
|
| Rate for Payer: Altius Commercial |
$505.92
|
| Rate for Payer: Beech Street Commercial |
$516.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$511.19
|
| Rate for Payer: Cash Price |
$368.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$511.19
|
| Rate for Payer: Cigna of WY Commercial |
$516.46
|
| Rate for Payer: Entrust Commercial |
$500.65
|
| Rate for Payer: First Choice Health Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$500.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.39
|
| Rate for Payer: HealthUtah PPO |
$527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$511.19
|
| Rate for Payer: Multiplan Medicare/VA |
$285.37
|
| Rate for Payer: One Health Plan of WY PPO |
$516.46
|
| Rate for Payer: PacificSource Commercial |
$474.30
|
| Rate for Payer: PHCS PPO |
$516.46
|
| Rate for Payer: Three Rivers PPO |
$395.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.39
|
| Rate for Payer: United Healthcare Commercial |
$503.28
|
| Rate for Payer: United Healthcare Medicare |
$300.39
|
| Rate for Payer: WINHealth Partners Commercial |
$516.46
|
| Rate for Payer: Wise Provider Network Commercial |
$500.65
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - POCT COLLAGEN TYPE I CROSSLINK
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Aetna of WY Medicare |
$75.52
|
| 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 |
$114.46
|
| 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 |
$71.98
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$68.38
|
| 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 |
$71.98
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$71.98
|
| Rate for Payer: WINHealth Partners Commercial |
$112.10
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY FOR COLLAGEN CROSS LINKS - POCT COLLAGEN TYPE I CROSSLINK
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
3018252301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.90 |
| 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 Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.46
|
| 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 |
$67.26
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$63.90
|
| 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 |
$67.26
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$67.26
|
| Rate for Payer: WINHealth Partners Commercial |
$115.64
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE BODY FLUID
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$42.88
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.87
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$38.83
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.87
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$40.87
|
| Rate for Payer: WINHealth Partners Commercial |
$63.65
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE BODY FLUID
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$44.22
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.19
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$36.28
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$38.19
|
| Rate for Payer: WINHealth Partners Commercial |
$65.66
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$44.22
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.19
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$36.28
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$38.19
|
| Rate for Payer: WINHealth Partners Commercial |
$65.66
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
3018294501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$42.88
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.87
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$38.83
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.87
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$40.87
|
| Rate for Payer: WINHealth Partners Commercial |
$63.65
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3018300301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.15
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$51.44
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$54.15
|
| Rate for Payer: United Healthcare Commercial |
$90.72
|
| Rate for Payer: United Healthcare Medicare |
$54.15
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
3018300301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$60.80
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.95
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$55.05
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.95
|
| Rate for Payer: United Healthcare Commercial |
$90.72
|
| Rate for Payer: United Healthcare Medicare |
$57.95
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC ASSAY INFLUENZA A BY PCR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$240.43 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$435.12
|
| Rate for Payer: Aetna of WY Medicare |
$293.04
|
| Rate for Payer: Altius Commercial |
$426.24
|
| Rate for Payer: Beech Street Commercial |
$435.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.68
|
| Rate for Payer: Cigna of WY Commercial |
$435.12
|
| Rate for Payer: Entrust Commercial |
$421.80
|
| Rate for Payer: First Choice Health Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.08
|
| Rate for Payer: HealthUtah PPO |
$444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.68
|
| Rate for Payer: Multiplan Medicare/VA |
$240.43
|
| Rate for Payer: One Health Plan of WY PPO |
$435.12
|
| Rate for Payer: PacificSource Commercial |
$399.60
|
| Rate for Payer: PHCS PPO |
$435.12
|
| Rate for Payer: Three Rivers PPO |
$333.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.08
|
| Rate for Payer: United Healthcare Commercial |
$424.02
|
| Rate for Payer: United Healthcare Medicare |
$253.08
|
| Rate for Payer: WINHealth Partners Commercial |
$435.12
|
| Rate for Payer: Wise Provider Network Commercial |
$421.80
|
|
|
HC ASSAY INFLUENZA A BY PCR
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$257.30 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$435.12
|
| Rate for Payer: Aetna of WY Medicare |
$284.16
|
| Rate for Payer: Altius Commercial |
$426.24
|
| Rate for Payer: Beech Street Commercial |
$435.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.68
|
| Rate for Payer: Cigna of WY Commercial |
$435.12
|
| Rate for Payer: Entrust Commercial |
$421.80
|
| Rate for Payer: First Choice Health Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.84
|
| Rate for Payer: HealthUtah PPO |
$444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.68
|
| Rate for Payer: Multiplan Medicare/VA |
$257.30
|
| Rate for Payer: One Health Plan of WY PPO |
$435.12
|
| Rate for Payer: PacificSource Commercial |
$399.60
|
| Rate for Payer: PHCS PPO |
$435.12
|
| Rate for Payer: Three Rivers PPO |
$333.00
|
| Rate for Payer: TriWest Veterans Administration |
$270.84
|
| Rate for Payer: United Healthcare Commercial |
$424.02
|
| Rate for Payer: United Healthcare Medicare |
$270.84
|
| Rate for Payer: WINHealth Partners Commercial |
$421.80
|
| Rate for Payer: Wise Provider Network Commercial |
$421.80
|
|
|
HC ASSAY INFLUENZA B BY PCR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$240.43 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$435.12
|
| Rate for Payer: Aetna of WY Medicare |
$293.04
|
| Rate for Payer: Altius Commercial |
$426.24
|
| Rate for Payer: Beech Street Commercial |
$435.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.68
|
| Rate for Payer: Cigna of WY Commercial |
$435.12
|
| Rate for Payer: Entrust Commercial |
$421.80
|
| Rate for Payer: First Choice Health Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.08
|
| Rate for Payer: HealthUtah PPO |
$444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.68
|
| Rate for Payer: Multiplan Medicare/VA |
$240.43
|
| Rate for Payer: One Health Plan of WY PPO |
$435.12
|
| Rate for Payer: PacificSource Commercial |
$399.60
|
| Rate for Payer: PHCS PPO |
$435.12
|
| Rate for Payer: Three Rivers PPO |
$333.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.08
|
| Rate for Payer: United Healthcare Commercial |
$424.02
|
| Rate for Payer: United Healthcare Medicare |
$253.08
|
| Rate for Payer: WINHealth Partners Commercial |
$435.12
|
| Rate for Payer: Wise Provider Network Commercial |
$421.80
|
|
