|
HC ASSAY OF INSULIN,FREE - INSULIN, FREE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 83527
|
| Hospital Charge Code |
3018352701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$52.48
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.02
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$47.52
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$50.02
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Medicare |
$50.02
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC ASSAY OF INSULIN,FREE - INSULIN, FREE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 83527
|
| Hospital Charge Code |
3018352701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$54.12
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.54
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.74
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$44.40
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Medicare |
$46.74
|
| Rate for Payer: WINHealth Partners Commercial |
$80.36
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC ASSAY OF INSULIN,TOTAL - INSULIN, FASTING
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
3018352501
|
|
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 INSULIN,TOTAL - INSULIN, FASTING
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
3018352501
|
|
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 INSULIN,TOTAL - INSULIN, TOTAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
3018352503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$71.04
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.71
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$64.32
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.71
|
| Rate for Payer: United Healthcare Medicare |
$67.71
|
| Rate for Payer: WINHealth Partners Commercial |
$105.45
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC ASSAY OF INSULIN,TOTAL - INSULIN, TOTAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
3018352503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$73.26
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.27
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$60.11
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$63.27
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WINHealth Partners Commercial |
$108.78
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC ASSAY OF INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
3008352901
|
|
Hospital Revenue Code
|
300
|
| 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 INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
3008352901
|
|
Hospital Revenue Code
|
300
|
| 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 IRON - IRON
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
3018354002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Aetna of WY Medicare |
$58.24
|
| Rate for Payer: Altius Commercial |
$87.36
|
| Rate for Payer: Beech Street Commercial |
$89.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$88.27
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: Entrust Commercial |
$86.45
|
| Rate for Payer: First Choice Health Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.51
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: Multiplan Medicare/VA |
$52.73
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$89.18
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.51
|
| Rate for Payer: United Healthcare Commercial |
$86.90
|
| Rate for Payer: United Healthcare Medicare |
$55.51
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
| Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
|
HC ASSAY OF IRON - IRON
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
3018354002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Aetna of WY Medicare |
$60.06
|
| Rate for Payer: Altius Commercial |
$87.36
|
| Rate for Payer: Beech Street Commercial |
$89.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$88.27
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: Entrust Commercial |
$86.45
|
| Rate for Payer: First Choice Health Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.87
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: Multiplan Medicare/VA |
$49.28
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$89.18
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: TriWest Veterans Administration |
$51.87
|
| Rate for Payer: United Healthcare Commercial |
$86.90
|
| Rate for Payer: United Healthcare Medicare |
$51.87
|
| Rate for Payer: WINHealth Partners Commercial |
$89.18
|
| Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
|
HC ASSAY OF LACOSAMIDE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 80235
|
| Hospital Charge Code |
3018023501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
HC ASSAY OF LACOSAMIDE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 80235
|
| Hospital Charge Code |
3018023501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
HC ASSAY OF LACTIC ACID - LACTATE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$92.80
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.45
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$84.03
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$88.45
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF LACTIC ACID - LACTATE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$78.52
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.65
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$82.65
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF LACTIC ACID - LACTIC ACID BODY FLUID
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$92.80
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.45
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$84.03
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$88.45
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF LACTIC ACID - LACTIC ACID BODY FLUID
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$78.52
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.65
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$82.65
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 83625
|
| Hospital Charge Code |
3018362501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$70.40
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$63.74
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 83625
|
| Hospital Charge Code |
3018362501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.70
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC ASSAY OF LEAD - LEAD 24HR URINE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3018365501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$115.20
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$104.31
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.80
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$109.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ASSAY OF LEAD - LEAD 24HR URINE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3018365501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.60
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$97.47
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.60
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare |
$102.60
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ASSAY OF LEAD - LEAD BLOOD
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3018365503
|
|
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 LEAD - LEAD BLOOD
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
3018365503
|
|
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 LECITHIN SPHENGOMYELIN
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 83661
|
| Hospital Charge Code |
3018366101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.88 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$125.40
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.30
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$102.88
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$108.30
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare |
$108.30
|
| Rate for Payer: WINHealth Partners Commercial |
$186.20
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC ASSAY OF LECITHIN SPHENGOMYELIN
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 83661
|
| Hospital Charge Code |
3018366101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$121.60
|
| Rate for Payer: Altius Commercial |
$182.40
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: Entrust Commercial |
$180.50
|
| Rate for Payer: First Choice Health Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.90
|
| Rate for Payer: HealthUtah PPO |
$190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$110.10
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.90
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare |
$115.90
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
| Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
|
HC ASSAY OF LEVETIRACETAM
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.88 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.72
|
| Rate for Payer: Aetna of WY Medicare |
$141.24
|
| Rate for Payer: Altius Commercial |
$205.44
|
| Rate for Payer: Beech Street Commercial |
$209.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$207.58
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.58
|
| Rate for Payer: Cigna of WY Commercial |
$209.72
|
| Rate for Payer: Entrust Commercial |
$203.30
|
| Rate for Payer: First Choice Health Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.98
|
| Rate for Payer: HealthUtah PPO |
$214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.58
|
| Rate for Payer: Multiplan Medicare/VA |
$115.88
|
| Rate for Payer: One Health Plan of WY PPO |
$209.72
|
| Rate for Payer: PacificSource Commercial |
$192.60
|
| Rate for Payer: PHCS PPO |
$209.72
|
| Rate for Payer: Three Rivers PPO |
$160.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.98
|
| Rate for Payer: United Healthcare Commercial |
$204.37
|
| Rate for Payer: United Healthcare Medicare |
$121.98
|
| Rate for Payer: WINHealth Partners Commercial |
$209.72
|
| Rate for Payer: Wise Provider Network Commercial |
$203.30
|
|
