|
HC ASSAY OF LEVETIRACETAM
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.72
|
| Rate for Payer: Aetna of WY Medicare |
$136.96
|
| 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 |
$130.54
|
| Rate for Payer: HealthUtah PPO |
$214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.58
|
| Rate for Payer: Multiplan Medicare/VA |
$124.01
|
| 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 |
$130.54
|
| Rate for Payer: United Healthcare Commercial |
$204.37
|
| Rate for Payer: United Healthcare Medicare |
$130.54
|
| Rate for Payer: WINHealth Partners Commercial |
$203.30
|
| Rate for Payer: Wise Provider Network Commercial |
$203.30
|
|
|
HC ASSAY OF LIPASE - LIPASE
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$104.94
|
| Rate for Payer: Altius Commercial |
$152.64
|
| Rate for Payer: Beech Street Commercial |
$155.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.23
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: Entrust Commercial |
$151.05
|
| Rate for Payer: First Choice Health Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.63
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$86.10
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$155.82
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.63
|
| Rate for Payer: United Healthcare Commercial |
$151.84
|
| Rate for Payer: United Healthcare Medicare |
$90.63
|
| Rate for Payer: WINHealth Partners Commercial |
$155.82
|
| Rate for Payer: Wise Provider Network Commercial |
$151.05
|
|
|
HC ASSAY OF LIPASE - LIPASE
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.14 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$101.76
|
| Rate for Payer: Altius Commercial |
$152.64
|
| Rate for Payer: Beech Street Commercial |
$155.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.23
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: Entrust Commercial |
$151.05
|
| Rate for Payer: First Choice Health Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.99
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$92.14
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$155.82
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$96.99
|
| Rate for Payer: United Healthcare Commercial |
$151.84
|
| Rate for Payer: United Healthcare Medicare |
$96.99
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
| Rate for Payer: Wise Provider Network Commercial |
$151.05
|
|
|
HC ASSAY OF LIPOPROTEIN (A)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
3018369501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$107.58
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.91
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.91
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$92.91
|
| Rate for Payer: WINHealth Partners Commercial |
$159.74
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ASSAY OF LIPOPROTEIN (A)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
3018369501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$104.32
|
| Rate for Payer: Altius Commercial |
$156.48
|
| Rate for Payer: Beech Street Commercial |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: Entrust Commercial |
$154.85
|
| Rate for Payer: First Choice Health Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.43
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$94.46
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$159.74
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.43
|
| Rate for Payer: United Healthcare Commercial |
$155.66
|
| Rate for Payer: United Healthcare Medicare |
$99.43
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
| Rate for Payer: Wise Provider Network Commercial |
$154.85
|
|
|
HC ASSAY OF LITHIUM - LITHIUM
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
3018017801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.26 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$54.40
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.45
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.85
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$49.26
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$51.85
|
| Rate for Payer: United Healthcare Commercial |
$81.18
|
| Rate for Payer: United Healthcare Medicare |
$51.85
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC ASSAY OF LITHIUM - LITHIUM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
3018017801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.45
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.45
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.03
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$48.45
|
| Rate for Payer: United Healthcare Commercial |
$81.18
|
| Rate for Payer: United Healthcare Medicare |
$48.45
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$80.64
|
| Rate for Payer: Altius Commercial |
$120.96
|
| Rate for Payer: Beech Street Commercial |
$123.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: Entrust Commercial |
$119.70
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.86
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$73.02
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$123.48
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$76.86
|
| Rate for Payer: United Healthcare Commercial |
$120.33
|
| Rate for Payer: United Healthcare Medicare |
$76.86
|
| Rate for Payer: WINHealth Partners Commercial |
$119.70
|
| Rate for Payer: Wise Provider Network Commercial |
$119.70
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.23 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$83.16
|
| Rate for Payer: Altius Commercial |
$120.96
|
| Rate for Payer: Beech Street Commercial |
$123.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: Entrust Commercial |
$119.70
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.82
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$68.23
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$123.48
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.82
|
| Rate for Payer: United Healthcare Commercial |
$120.33
|
| Rate for Payer: United Healthcare Medicare |
$71.82
|
| Rate for Payer: WINHealth Partners Commercial |
$123.48
|
| Rate for Payer: Wise Provider Network Commercial |
$119.70
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM 24HR URINE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM 24HR URINE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM FECAL
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.30
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM FECAL
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$57.60
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.90
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM RBC
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.88
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.12
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$53.31
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.12
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$56.12
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM RBC
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$60.72
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.44
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.82
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.44
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
| Rate for Payer: WINHealth Partners Commercial |
$90.16
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM URINE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.30
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM URINE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$57.60
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.90
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$52.16
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$85.95
|
| Rate for Payer: United Healthcare Medicare |
$54.90
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF MANGANESE - MANGANESE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 83785
|
| Hospital Charge Code |
3018378501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$223.10
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.10
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$124.54
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$131.10
|
| Rate for Payer: United Healthcare Commercial |
$219.65
|
| Rate for Payer: United Healthcare Medicare |
$131.10
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ASSAY OF MANGANESE - MANGANESE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 83785
|
| Hospital Charge Code |
3018378501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$147.20
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$223.10
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.30
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$133.28
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.30
|
| Rate for Payer: United Healthcare Commercial |
$219.65
|
| Rate for Payer: United Healthcare Medicare |
$140.30
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ASSAY OF MERCURY - MERCURY 24 HOUR URINE
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3018382501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.88
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.12
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$53.31
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.12
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$56.12
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF MERCURY - MERCURY 24 HOUR URINE
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3018382501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$60.72
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.44
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.82
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.44
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
| Rate for Payer: WINHealth Partners Commercial |
$90.16
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF MERCURY - MERCURY, BLOOD
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3018382503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.09 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$109.44
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.31
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$99.09
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$104.31
|
| Rate for Payer: WINHealth Partners Commercial |
$162.45
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC ASSAY OF MERCURY - MERCURY, BLOOD
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
3018382503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$112.86
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.47
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$92.60
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.47
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$97.47
|
| Rate for Payer: WINHealth Partners Commercial |
$167.58
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR PLASMA FREE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3028383503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.76 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$151.04
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.96
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$136.76
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.96
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$143.96
|
| Rate for Payer: WINHealth Partners Commercial |
$224.20
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR PLASMA FREE
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3028383503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$155.76
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.52
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$127.79
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$134.52
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$134.52
|
| Rate for Payer: WINHealth Partners Commercial |
$231.28
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
