|
HC ASSAY OF COPPER - COPPER RANDOM URINE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$86.40
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.35
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$78.23
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC ASSAY OF COPPER - COPPER, SERUM
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$136.22
|
| Rate for Payer: Aetna of WY Medicare |
$88.96
|
| Rate for Payer: Altius Commercial |
$133.44
|
| Rate for Payer: Beech Street Commercial |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.83
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.83
|
| Rate for Payer: Cigna of WY Commercial |
$136.22
|
| Rate for Payer: Entrust Commercial |
$132.05
|
| Rate for Payer: First Choice Health Commercial |
$132.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$132.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.79
|
| Rate for Payer: HealthUtah PPO |
$139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.83
|
| Rate for Payer: Multiplan Medicare/VA |
$80.55
|
| Rate for Payer: One Health Plan of WY PPO |
$136.22
|
| Rate for Payer: PacificSource Commercial |
$125.10
|
| Rate for Payer: PHCS PPO |
$136.22
|
| Rate for Payer: Three Rivers PPO |
$104.25
|
| Rate for Payer: TriWest Veterans Administration |
$84.79
|
| Rate for Payer: United Healthcare Commercial |
$132.74
|
| Rate for Payer: United Healthcare Medicare |
$84.79
|
| Rate for Payer: WINHealth Partners Commercial |
$132.05
|
| Rate for Payer: Wise Provider Network Commercial |
$132.05
|
|
|
HC ASSAY OF COPPER - COPPER, SERUM
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 82525
|
| Hospital Charge Code |
3018252504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$136.22
|
| Rate for Payer: Aetna of WY Medicare |
$91.74
|
| Rate for Payer: Altius Commercial |
$133.44
|
| Rate for Payer: Beech Street Commercial |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.83
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.83
|
| Rate for Payer: Cigna of WY Commercial |
$136.22
|
| Rate for Payer: Entrust Commercial |
$132.05
|
| Rate for Payer: First Choice Health Commercial |
$132.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$132.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.23
|
| Rate for Payer: HealthUtah PPO |
$139.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.83
|
| Rate for Payer: Multiplan Medicare/VA |
$75.27
|
| Rate for Payer: One Health Plan of WY PPO |
$136.22
|
| Rate for Payer: PacificSource Commercial |
$125.10
|
| Rate for Payer: PHCS PPO |
$136.22
|
| Rate for Payer: Three Rivers PPO |
$104.25
|
| Rate for Payer: TriWest Veterans Administration |
$79.23
|
| Rate for Payer: United Healthcare Commercial |
$132.74
|
| Rate for Payer: United Healthcare Medicare |
$79.23
|
| Rate for Payer: WINHealth Partners Commercial |
$136.22
|
| Rate for Payer: Wise Provider Network Commercial |
$132.05
|
|
|
HC ASSAY OF CORTICOSTEROIDS - 17-HYDROXYCORTICOSTEROIDS, URINE, 24 HOUR
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
3018349102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$98.56
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.94
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.24
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.94
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$93.94
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ASSAY OF CORTICOSTEROIDS - 17-HYDROXYCORTICOSTEROIDS, URINE, 24 HOUR
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
3018349102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.38
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$147.07
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC ASSAY OF C-PEPTIDE - C-PEPTIDE
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
3018468101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$142.56
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.52
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.12
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$116.96
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$123.12
|
| Rate for Payer: United Healthcare Commercial |
$206.28
|
| Rate for Payer: United Healthcare Medicare |
$123.12
|
| Rate for Payer: WINHealth Partners Commercial |
$211.68
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC ASSAY OF C-PEPTIDE - C-PEPTIDE
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
3018468101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.17 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$138.24
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$209.52
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.76
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$125.17
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$131.76
|
| Rate for Payer: United Healthcare Commercial |
$206.28
|
| Rate for Payer: United Healthcare Medicare |
$131.76
|
| Rate for Payer: WINHealth Partners Commercial |
$205.20
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC ASSAY OF CREATININE - CREATININE SERUM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
3018256501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$44.80
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.90
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.70
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$40.56
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare |
$42.70
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ASSAY OF CREATININE - CREATININE SERUM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
3018256501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.90
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.90
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$37.90
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare |
$39.90
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC ASSAY OF CRYOFIBRINOGEN - CRYOFIBRINOGEN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82585
|
| Hospital Charge Code |
3018258501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.08
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.42
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$70.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$74.42
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC ASSAY OF CRYOFIBRINOGEN - CRYOFIBRINOGEN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82585
|
| Hospital Charge Code |
3018258501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 82595
|
| Hospital Charge Code |
3018259501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.60
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.32
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 82595
|
| Hospital Charge Code |
3018259501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.20
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$46.36
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.80
|
| Rate for Payer: United Healthcare Commercial |
$76.40
|
| Rate for Payer: United Healthcare Medicare |
$48.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
3018015801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Aetna of WY Medicare |
$81.28
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.19
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.47
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$73.60
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$77.47
|
| Rate for Payer: United Healthcare Commercial |
$121.28
|
| Rate for Payer: United Healthcare Medicare |
$77.47
|
| Rate for Payer: WINHealth Partners Commercial |
$120.65
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
3018015801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.77 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Aetna of WY Medicare |
$83.82
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.19
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.39
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$68.77
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$72.39
|
| Rate for Payer: United Healthcare Commercial |
$121.28
|
| Rate for Payer: United Healthcare Medicare |
$72.39
|
| Rate for Payer: WINHealth Partners Commercial |
$124.46
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC ASSAY OF CYSTATIN C
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 82610
|
| Hospital Charge Code |
3018261001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.63 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$227.36
|
| Rate for Payer: Aetna of WY Medicare |
$153.12
|
| Rate for Payer: Altius Commercial |
$222.72
|
| Rate for Payer: Beech Street Commercial |
$227.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.04
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$225.04
|
| Rate for Payer: Cigna of WY Commercial |
$227.36
|
| Rate for Payer: Entrust Commercial |
$220.40
|
| Rate for Payer: First Choice Health Commercial |
$220.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$220.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.24
|
| Rate for Payer: HealthUtah PPO |
$232.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$225.04
|
| Rate for Payer: Multiplan Medicare/VA |
$125.63
|
| Rate for Payer: One Health Plan of WY PPO |
$227.36
|
| Rate for Payer: PacificSource Commercial |
$208.80
|
| Rate for Payer: PHCS PPO |
$227.36
|
| Rate for Payer: Three Rivers PPO |
$174.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$221.56
|
| Rate for Payer: United Healthcare Medicare |
$132.24
|
| Rate for Payer: WINHealth Partners Commercial |
$227.36
|
| Rate for Payer: Wise Provider Network Commercial |
$220.40
|
|
|
HC ASSAY OF CYSTATIN C
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 82610
|
| Hospital Charge Code |
3018261001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$134.44 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$227.36
|
| Rate for Payer: Aetna of WY Medicare |
$148.48
|
| Rate for Payer: Altius Commercial |
$222.72
|
| Rate for Payer: Beech Street Commercial |
$227.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$225.04
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$225.04
|
| Rate for Payer: Cigna of WY Commercial |
$227.36
|
| Rate for Payer: Entrust Commercial |
$220.40
|
| Rate for Payer: First Choice Health Commercial |
$220.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$220.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.52
|
| Rate for Payer: HealthUtah PPO |
$232.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$225.04
|
| Rate for Payer: Multiplan Medicare/VA |
$134.44
|
| Rate for Payer: One Health Plan of WY PPO |
$227.36
|
| Rate for Payer: PacificSource Commercial |
$208.80
|
| Rate for Payer: PHCS PPO |
$227.36
|
| Rate for Payer: Three Rivers PPO |
$174.00
|
| Rate for Payer: TriWest Veterans Administration |
$141.52
|
| Rate for Payer: United Healthcare Commercial |
$221.56
|
| Rate for Payer: United Healthcare Medicare |
$141.52
|
| Rate for Payer: WINHealth Partners Commercial |
$220.40
|
| Rate for Payer: Wise Provider Network Commercial |
$220.40
|
|
|
HC ASSAY OF DIBUCAINE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82638
|
| Hospital Charge Code |
3018263801
|
|
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 DIBUCAINE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82638
|
| Hospital Charge Code |
3018263801
|
|
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 ERYTHROPOIETIN - ERYTHROPOIETIN
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
3018266801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$146.52
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.54
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$120.21
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.54
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$126.54
|
| Rate for Payer: WINHealth Partners Commercial |
$217.56
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
|
HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
3018266801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$142.08
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.42
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$128.65
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.42
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WINHealth Partners Commercial |
$210.90
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
|
HC ASSAY OF ESTRADIOL - ESTRADIOL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
3018267001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.02 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$149.12
|
| Rate for Payer: Altius Commercial |
$223.68
|
| Rate for Payer: Beech Street Commercial |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.01
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Entrust Commercial |
$221.35
|
| Rate for Payer: First Choice Health Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.13
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$135.02
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$228.34
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.13
|
| Rate for Payer: United Healthcare Commercial |
$222.52
|
| Rate for Payer: United Healthcare Medicare |
$142.13
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
| Rate for Payer: Wise Provider Network Commercial |
$221.35
|
|
|
HC ASSAY OF ESTRADIOL - ESTRADIOL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
3018267001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.17 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$153.78
|
| Rate for Payer: Altius Commercial |
$223.68
|
| Rate for Payer: Beech Street Commercial |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.01
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Entrust Commercial |
$221.35
|
| Rate for Payer: First Choice Health Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.81
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$126.17
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$228.34
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.81
|
| Rate for Payer: United Healthcare Commercial |
$222.52
|
| Rate for Payer: United Healthcare Medicare |
$132.81
|
| Rate for Payer: WINHealth Partners Commercial |
$228.34
|
| Rate for Payer: Wise Provider Network Commercial |
$221.35
|
|
|
HC ASSAY OF ESTRIOL
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
3018267702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.29
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$52.53
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$55.29
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC ASSAY OF ESTRIOL
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
3018267702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$62.08
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
