|
HC ASSAY OF ESTRONE - ESTRONE
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
3018267902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.66 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$310.66
|
| Rate for Payer: Aetna of WY Medicare |
$209.22
|
| Rate for Payer: Altius Commercial |
$304.32
|
| Rate for Payer: Beech Street Commercial |
$310.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.49
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$307.49
|
| Rate for Payer: Cigna of WY Commercial |
$310.66
|
| Rate for Payer: Entrust Commercial |
$301.15
|
| Rate for Payer: First Choice Health Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.69
|
| Rate for Payer: HealthUtah PPO |
$317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$307.49
|
| Rate for Payer: Multiplan Medicare/VA |
$171.66
|
| Rate for Payer: One Health Plan of WY PPO |
$310.66
|
| Rate for Payer: PacificSource Commercial |
$285.30
|
| Rate for Payer: PHCS PPO |
$310.66
|
| Rate for Payer: Three Rivers PPO |
$237.75
|
| Rate for Payer: TriWest Veterans Administration |
$180.69
|
| Rate for Payer: United Healthcare Commercial |
$302.74
|
| Rate for Payer: United Healthcare Medicare |
$180.69
|
| Rate for Payer: WINHealth Partners Commercial |
$310.66
|
| Rate for Payer: Wise Provider Network Commercial |
$301.15
|
|
|
HC ASSAY OF ESTRONE - ESTRONE
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
3018267902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.70 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$310.66
|
| Rate for Payer: Aetna of WY Medicare |
$202.88
|
| Rate for Payer: Altius Commercial |
$304.32
|
| Rate for Payer: Beech Street Commercial |
$310.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.49
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$307.49
|
| Rate for Payer: Cigna of WY Commercial |
$310.66
|
| Rate for Payer: Entrust Commercial |
$301.15
|
| Rate for Payer: First Choice Health Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.37
|
| Rate for Payer: HealthUtah PPO |
$317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$307.49
|
| Rate for Payer: Multiplan Medicare/VA |
$183.70
|
| Rate for Payer: One Health Plan of WY PPO |
$310.66
|
| Rate for Payer: PacificSource Commercial |
$285.30
|
| Rate for Payer: PHCS PPO |
$310.66
|
| Rate for Payer: Three Rivers PPO |
$237.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.37
|
| Rate for Payer: United Healthcare Commercial |
$302.74
|
| Rate for Payer: United Healthcare Medicare |
$193.37
|
| Rate for Payer: WINHealth Partners Commercial |
$301.15
|
| Rate for Payer: Wise Provider Network Commercial |
$301.15
|
|
|
HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 80168
|
| Hospital Charge Code |
3018016801
|
|
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 ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 80168
|
| Hospital Charge Code |
3018016801
|
|
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 ETHYLENE GLYCOL - ETHYLENE GLYCOL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
3018269301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$84.48
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.96
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$69.31
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$72.96
|
| Rate for Payer: WINHealth Partners Commercial |
$125.44
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
3018269301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$81.92
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.16
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.08
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$74.18
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.08
|
| Rate for Payer: United Healthcare Commercial |
$122.24
|
| Rate for Payer: United Healthcare Medicare |
$78.08
|
| Rate for Payer: WINHealth Partners Commercial |
$121.60
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.59
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.79
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$79.60
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$83.79
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$83.79
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$94.08
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.59
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.67
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$85.19
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.67
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$89.67
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC ASSAY OF FETAL FIBRONECTIN - FETAL FIBRONECTIN
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
3018273101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$354.65 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$599.76
|
| Rate for Payer: Aetna of WY Medicare |
$391.68
|
| Rate for Payer: Altius Commercial |
$587.52
|
| Rate for Payer: Beech Street Commercial |
$599.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$593.64
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$593.64
|
| Rate for Payer: Cigna of WY Commercial |
$599.76
|
| Rate for Payer: Entrust Commercial |
$581.40
|
| Rate for Payer: First Choice Health Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$373.32
|
| Rate for Payer: HealthUtah PPO |
$612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$593.64
|
| Rate for Payer: Multiplan Medicare/VA |
$354.65
|
| Rate for Payer: One Health Plan of WY PPO |
$599.76
|
| Rate for Payer: PacificSource Commercial |
$550.80
|
| Rate for Payer: PHCS PPO |
$599.76
|
| Rate for Payer: Three Rivers PPO |
$459.00
|
| Rate for Payer: TriWest Veterans Administration |
$373.32
|
| Rate for Payer: United Healthcare Commercial |
$584.46
|
| Rate for Payer: United Healthcare Medicare |
$373.32
|
| Rate for Payer: WINHealth Partners Commercial |
$581.40
|
| Rate for Payer: Wise Provider Network Commercial |
$581.40
|
|
|
HC ASSAY OF FETAL FIBRONECTIN - FETAL FIBRONECTIN
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
3018273101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$599.76
|
| Rate for Payer: Aetna of WY Medicare |
$403.92
|
| Rate for Payer: Altius Commercial |
$587.52
|
| Rate for Payer: Beech Street Commercial |
$599.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$593.64
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$593.64
|
| Rate for Payer: Cigna of WY Commercial |
$599.76
|
| Rate for Payer: Entrust Commercial |
$581.40
|
| Rate for Payer: First Choice Health Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.84
|
| Rate for Payer: HealthUtah PPO |
$612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$593.64
|
| Rate for Payer: Multiplan Medicare/VA |
$331.40
|
| Rate for Payer: One Health Plan of WY PPO |
$599.76
|
| Rate for Payer: PacificSource Commercial |
$550.80
|
| Rate for Payer: PHCS PPO |
$599.76
|
| Rate for Payer: Three Rivers PPO |
$459.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.84
|
| Rate for Payer: United Healthcare Commercial |
$584.46
|
| Rate for Payer: United Healthcare Medicare |
$348.84
|
| Rate for Payer: WINHealth Partners Commercial |
$599.76
|
| Rate for Payer: Wise Provider Network Commercial |
$581.40
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID 24 HR URINE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
3018315002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$123.52
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.73
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$111.84
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$117.73
|
| Rate for Payer: WINHealth Partners Commercial |
$183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID 24 HR URINE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
3018315002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$127.38
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.01
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$104.51
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$110.01
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$110.01
|
| Rate for Payer: WINHealth Partners Commercial |
$189.14
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID URINE
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
3018315001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$123.52
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.73
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$111.84
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$117.73
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$117.73
|
| Rate for Payer: WINHealth Partners Commercial |
$183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC ASSAY OF FOR HVA - HOMOVANILLIC ACID URINE
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 83150
|
| Hospital Charge Code |
3018315001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.51 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$127.38
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.21
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.01
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$104.51
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$110.01
|
| Rate for Payer: United Healthcare Commercial |
$184.32
|
| Rate for Payer: United Healthcare Medicare |
$110.01
|
| Rate for Payer: WINHealth Partners Commercial |
$189.14
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.31 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.44
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.64
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$82.31
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$86.64
|
| Rate for Payer: United Healthcare Commercial |
$145.16
|
| Rate for Payer: United Healthcare Medicare |
$86.64
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$97.28
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.44
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.72
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$88.08
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.72
|
| Rate for Payer: United Healthcare Commercial |
$145.16
|
| Rate for Payer: United Healthcare Medicare |
$92.72
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
3018295501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.50
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$81.22
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$143.25
|
| Rate for Payer: United Healthcare Medicare |
$85.50
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
3018295501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.92 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$96.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.50
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$86.92
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$143.25
|
| Rate for Payer: United Healthcare Medicare |
$91.50
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$139.92
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.84
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$114.80
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$120.84
|
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: United Healthcare Medicare |
$120.84
|
| Rate for Payer: WINHealth Partners Commercial |
$207.76
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$135.68
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.32
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$122.85
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.32
|
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: United Healthcare Medicare |
$129.32
|
| Rate for Payer: WINHealth Partners Commercial |
$201.40
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA SERUM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278409
|
|
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 GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA SERUM
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278409
|
|
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 GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$139.92
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.84
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$114.80
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$120.84
|
| Rate for Payer: United Healthcare Medicare |
$120.84
|
| Rate for Payer: WINHealth Partners Commercial |
$207.76
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$135.68
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.32
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$122.85
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.32
|
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: United Healthcare Medicare |
$129.32
|
| Rate for Payer: WINHealth Partners Commercial |
$201.40
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG SERUM
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.24
|
| Rate for Payer: Aetna of WY Medicare |
$91.08
|
| Rate for Payer: Altius Commercial |
$132.48
|
| Rate for Payer: Beech Street Commercial |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.86
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.86
|
| Rate for Payer: Cigna of WY Commercial |
$135.24
|
| Rate for Payer: Entrust Commercial |
$131.10
|
| Rate for Payer: First Choice Health Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.66
|
| Rate for Payer: HealthUtah PPO |
$138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.86
|
| Rate for Payer: Multiplan Medicare/VA |
$74.73
|
| Rate for Payer: One Health Plan of WY PPO |
$135.24
|
| Rate for Payer: PacificSource Commercial |
$124.20
|
| Rate for Payer: PHCS PPO |
$135.24
|
| Rate for Payer: Three Rivers PPO |
$103.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.66
|
| Rate for Payer: United Healthcare Commercial |
$131.79
|
| Rate for Payer: United Healthcare Medicare |
$78.66
|
| Rate for Payer: WINHealth Partners Commercial |
$135.24
|
| Rate for Payer: Wise Provider Network Commercial |
$131.10
|
|
