|
HC ASSAY OF AMIKACIN - AMIKACIN TROUGH
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
3018015003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC ASSAY OF AMIKACIN - AMIKACIN TROUGH
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
3018015003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC ASSAY OF AMMONIA - AMMONIA
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
3018214001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$114.84
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.18
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$94.22
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.18
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$99.18
|
| Rate for Payer: WINHealth Partners Commercial |
$170.52
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC ASSAY OF AMMONIA - AMMONIA
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
3018214001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$111.36
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.14
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$106.14
|
| Rate for Payer: WINHealth Partners Commercial |
$165.30
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC ASSAY OF AMYLASE - AMYLASE
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.77 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Aetna of WY Medicare |
$99.66
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.47
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.07
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$81.77
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$144.20
|
| Rate for Payer: United Healthcare Medicare |
$86.07
|
| Rate for Payer: WINHealth Partners Commercial |
$147.98
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC ASSAY OF AMYLASE - AMYLASE
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.98
|
| Rate for Payer: Aetna of WY Medicare |
$96.64
|
| Rate for Payer: Altius Commercial |
$144.96
|
| Rate for Payer: Beech Street Commercial |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.47
|
| Rate for Payer: Cash Price |
$105.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.47
|
| Rate for Payer: Cigna of WY Commercial |
$147.98
|
| Rate for Payer: Entrust Commercial |
$143.45
|
| Rate for Payer: First Choice Health Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.11
|
| Rate for Payer: HealthUtah PPO |
$151.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.47
|
| Rate for Payer: Multiplan Medicare/VA |
$87.50
|
| Rate for Payer: One Health Plan of WY PPO |
$147.98
|
| Rate for Payer: PacificSource Commercial |
$135.90
|
| Rate for Payer: PHCS PPO |
$147.98
|
| Rate for Payer: Three Rivers PPO |
$113.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.11
|
| Rate for Payer: United Healthcare Commercial |
$144.20
|
| Rate for Payer: United Healthcare Medicare |
$92.11
|
| Rate for Payer: WINHealth Partners Commercial |
$143.45
|
| Rate for Payer: Wise Provider Network Commercial |
$143.45
|
|
|
HC ASSAY OF AMYLASE - AMYLASE BODY FLUID
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.07 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Aetna of WY Medicare |
$64.68
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.06
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.86
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$53.07
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$55.86
|
| Rate for Payer: United Healthcare Commercial |
$93.59
|
| Rate for Payer: United Healthcare Medicare |
$55.86
|
| Rate for Payer: WINHealth Partners Commercial |
$96.04
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC ASSAY OF AMYLASE - AMYLASE BODY FLUID
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.79 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Aetna of WY Medicare |
$62.72
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.06
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.78
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$56.79
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.78
|
| Rate for Payer: United Healthcare Commercial |
$93.59
|
| Rate for Payer: United Healthcare Medicare |
$59.78
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 82157
|
| Hospital Charge Code |
3018215701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Aetna of WY Medicare |
$133.98
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.91
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.71
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$109.92
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.71
|
| Rate for Payer: United Healthcare Commercial |
$193.86
|
| Rate for Payer: United Healthcare Medicare |
$115.71
|
| Rate for Payer: WINHealth Partners Commercial |
$198.94
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 82157
|
| Hospital Charge Code |
3018215701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Aetna of WY Medicare |
$129.92
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.91
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.83
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$117.64
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$123.83
|
| Rate for Payer: United Healthcare Commercial |
$193.86
|
| Rate for Payer: United Healthcare Medicare |
$123.83
|
| Rate for Payer: WINHealth Partners Commercial |
$192.85
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC ASSAY OF APOLIPOPROTEIN EACH
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3018217202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| 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 Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.40
|
| 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 |
$68.40
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$64.98
|
| 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 |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$68.40
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF APOLIPOPROTEIN EACH
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3018217202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$76.80
|
| 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 |
$116.40
|
| 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 |
$73.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$69.54
|
| 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 |
$73.20
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3018217201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$76.80
|
| 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 |
$116.40
|
| 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 |
$73.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$69.54
|
| 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 |
$73.20
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
3018217201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| 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 Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.40
|
| 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 |
$68.40
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$64.98
|
| 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 |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$68.40
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF ARSENIC - ARSENIC RANDOM URINE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3018217503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.01 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$68.48
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.79
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.27
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$62.01
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.27
|
| Rate for Payer: United Healthcare Medicare |
$65.27
|
| Rate for Payer: WINHealth Partners Commercial |
$101.65
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC ASSAY OF ARSENIC - ARSENIC RANDOM URINE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3018217503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$70.62
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.79
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.99
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$57.94
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.99
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$60.99
|
| Rate for Payer: WINHealth Partners Commercial |
$104.86
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC ASSAY OF ARSENIC - ARSENIC SERUM
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3018217505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.01 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$68.48
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.79
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.27
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$62.01
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.27
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$65.27
|
| Rate for Payer: WINHealth Partners Commercial |
$101.65
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC ASSAY OF ARSENIC - ARSENIC SERUM
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
3018217505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$70.62
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.79
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.99
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$57.94
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.99
|
| Rate for Payer: United Healthcare Commercial |
$102.18
|
| Rate for Payer: United Healthcare Medicare |
$60.99
|
| Rate for Payer: WINHealth Partners Commercial |
$104.86
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC ASSAY OF ASCORBIC ACID - VITAMIN C
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
3018218001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.32
|
| Rate for Payer: Aetna of WY Medicare |
$85.76
|
| Rate for Payer: Altius Commercial |
$128.64
|
| Rate for Payer: Beech Street Commercial |
$131.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.98
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.98
|
| Rate for Payer: Cigna of WY Commercial |
$131.32
|
| Rate for Payer: Entrust Commercial |
$127.30
|
| Rate for Payer: First Choice Health Commercial |
$127.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.74
|
| Rate for Payer: HealthUtah PPO |
$134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.98
|
| Rate for Payer: Multiplan Medicare/VA |
$77.65
|
| Rate for Payer: One Health Plan of WY PPO |
$131.32
|
| Rate for Payer: PacificSource Commercial |
$120.60
|
| Rate for Payer: PHCS PPO |
$131.32
|
| Rate for Payer: Three Rivers PPO |
$100.50
|
| Rate for Payer: TriWest Veterans Administration |
$81.74
|
| Rate for Payer: United Healthcare Commercial |
$127.97
|
| Rate for Payer: United Healthcare Medicare |
$81.74
|
| Rate for Payer: WINHealth Partners Commercial |
$127.30
|
| Rate for Payer: Wise Provider Network Commercial |
$127.30
|
|
|
HC ASSAY OF ASCORBIC ACID - VITAMIN C
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
3018218001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.32
|
| Rate for Payer: Aetna of WY Medicare |
$88.44
|
| Rate for Payer: Altius Commercial |
$128.64
|
| Rate for Payer: Beech Street Commercial |
$131.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.98
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.98
|
| Rate for Payer: Cigna of WY Commercial |
$131.32
|
| Rate for Payer: Entrust Commercial |
$127.30
|
| Rate for Payer: First Choice Health Commercial |
$127.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.38
|
| Rate for Payer: HealthUtah PPO |
$134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.98
|
| Rate for Payer: Multiplan Medicare/VA |
$72.56
|
| Rate for Payer: One Health Plan of WY PPO |
$131.32
|
| Rate for Payer: PacificSource Commercial |
$120.60
|
| Rate for Payer: PHCS PPO |
$131.32
|
| Rate for Payer: Three Rivers PPO |
$100.50
|
| Rate for Payer: TriWest Veterans Administration |
$76.38
|
| Rate for Payer: United Healthcare Commercial |
$127.97
|
| Rate for Payer: United Healthcare Medicare |
$76.38
|
| Rate for Payer: WINHealth Partners Commercial |
$131.32
|
| Rate for Payer: Wise Provider Network Commercial |
$127.30
|
|
|
HC ASSAY OF BLOOD CHLORIDE - CHLORIDE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
3018243501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: United Healthcare Commercial |
$41.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$27.52
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.71
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.23
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.92
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.23
|
| Rate for Payer: United Healthcare Medicare |
$26.23
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC ASSAY OF BLOOD CHLORIDE - CHLORIDE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
3018243501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.71
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.51
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.28
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.51
|
| Rate for Payer: United Healthcare Commercial |
$41.06
|
| Rate for Payer: United Healthcare Medicare |
$24.51
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC ASSAY OF BLOOD FATTY ACIDS - FATTY ACIDS, FREE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 82725
|
| Hospital Charge Code |
3018272501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$131.84
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.82
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.66
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$119.38
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.66
|
| Rate for Payer: United Healthcare Commercial |
$196.73
|
| Rate for Payer: United Healthcare Medicare |
$125.66
|
| Rate for Payer: WINHealth Partners Commercial |
$195.70
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
|
HC ASSAY OF BLOOD FATTY ACIDS - FATTY ACIDS, FREE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 82725
|
| Hospital Charge Code |
3018272501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$135.96
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.82
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.42
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$111.55
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$117.42
|
| Rate for Payer: United Healthcare Commercial |
$196.73
|
| Rate for Payer: United Healthcare Medicare |
$117.42
|
| Rate for Payer: WINHealth Partners Commercial |
$201.88
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
|
HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST - HDL CHOLESTEROL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
3018371801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$164.64
|
| Rate for Payer: Aetna of WY Medicare |
$110.88
|
| Rate for Payer: Altius Commercial |
$161.28
|
| Rate for Payer: Beech Street Commercial |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.96
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$162.96
|
| Rate for Payer: Cigna of WY Commercial |
$164.64
|
| Rate for Payer: Entrust Commercial |
$159.60
|
| Rate for Payer: First Choice Health Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.76
|
| Rate for Payer: HealthUtah PPO |
$168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$162.96
|
| Rate for Payer: Multiplan Medicare/VA |
$90.97
|
| Rate for Payer: One Health Plan of WY PPO |
$164.64
|
| Rate for Payer: PacificSource Commercial |
$151.20
|
| Rate for Payer: PHCS PPO |
$164.64
|
| Rate for Payer: Three Rivers PPO |
$126.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.76
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Medicare |
$95.76
|
| Rate for Payer: WINHealth Partners Commercial |
$164.64
|
| Rate for Payer: Wise Provider Network Commercial |
$159.60
|
|
