|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$135.96
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.82
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.42
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$111.55
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$117.42
|
| Rate for Payer: United Healthcare Commercial |
$196.73
|
| Rate for Payer: United Healthcare Medicare |
$117.42
|
| Rate for Payer: WINHealth Partners Commercial |
$201.88
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
|
HC ASSAY OF VOLATILES - VOLATILE COMPOUNDS
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
3018460001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.89
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$86.35
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$90.89
|
| Rate for Payer: United Healthcare Medicare |
$90.89
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC ASSAY OF VOLATILES - VOLATILE COMPOUNDS
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
3018460001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.93
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$80.68
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.93
|
| Rate for Payer: United Healthcare Commercial |
$142.30
|
| Rate for Payer: United Healthcare Medicare |
$84.93
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC ASSAY OF ZINC - ZINC
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463001
|
|
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 ZINC - ZINC
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463001
|
|
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 ZINC - ZINC RBC
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$141.12
|
| Rate for Payer: Aetna of WY Medicare |
$95.04
|
| Rate for Payer: Altius Commercial |
$138.24
|
| Rate for Payer: Beech Street Commercial |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.68
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.68
|
| Rate for Payer: Cigna of WY Commercial |
$141.12
|
| Rate for Payer: Entrust Commercial |
$136.80
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.08
|
| Rate for Payer: HealthUtah PPO |
$144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.68
|
| Rate for Payer: Multiplan Medicare/VA |
$77.98
|
| Rate for Payer: One Health Plan of WY PPO |
$141.12
|
| Rate for Payer: PacificSource Commercial |
$129.60
|
| Rate for Payer: PHCS PPO |
$141.12
|
| Rate for Payer: Three Rivers PPO |
$108.00
|
| Rate for Payer: TriWest Veterans Administration |
$82.08
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
| Rate for Payer: United Healthcare Medicare |
$82.08
|
| Rate for Payer: WINHealth Partners Commercial |
$141.12
|
| Rate for Payer: Wise Provider Network Commercial |
$136.80
|
|
|
HC ASSAY OF ZINC - ZINC RBC
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.45 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$141.12
|
| Rate for Payer: Aetna of WY Medicare |
$92.16
|
| Rate for Payer: Altius Commercial |
$138.24
|
| Rate for Payer: Beech Street Commercial |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.68
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.68
|
| Rate for Payer: Cigna of WY Commercial |
$141.12
|
| Rate for Payer: Entrust Commercial |
$136.80
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.84
|
| Rate for Payer: HealthUtah PPO |
$144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.68
|
| Rate for Payer: Multiplan Medicare/VA |
$83.45
|
| Rate for Payer: One Health Plan of WY PPO |
$141.12
|
| Rate for Payer: PacificSource Commercial |
$129.60
|
| Rate for Payer: PHCS PPO |
$141.12
|
| Rate for Payer: Three Rivers PPO |
$108.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.84
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
| Rate for Payer: United Healthcare Medicare |
$87.84
|
| Rate for Payer: WINHealth Partners Commercial |
$136.80
|
| Rate for Payer: Wise Provider Network Commercial |
$136.80
|
|
|
HC ASSAY OF ZINC - ZINC URINE
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$52.14
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.63
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.03
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$42.78
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$45.03
|
| Rate for Payer: United Healthcare Commercial |
$75.44
|
| Rate for Payer: United Healthcare Medicare |
$45.03
|
| Rate for Payer: WINHealth Partners Commercial |
$77.42
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC ASSAY OF ZINC - ZINC URINE
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
3018463002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$50.56
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.63
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$45.78
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$75.44
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$75.05
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC ASSAY OF ZONISAMIDE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
3018020301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.85 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.42
|
| Rate for Payer: Aetna of WY Medicare |
$85.14
|
| Rate for Payer: Altius Commercial |
$123.84
|
| Rate for Payer: Beech Street Commercial |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.13
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.13
|
| Rate for Payer: Cigna of WY Commercial |
$126.42
|
| Rate for Payer: Entrust Commercial |
$122.55
|
| Rate for Payer: First Choice Health Commercial |
$122.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$122.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.53
|
| Rate for Payer: HealthUtah PPO |
$129.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.13
|
| Rate for Payer: Multiplan Medicare/VA |
$69.85
|
| Rate for Payer: One Health Plan of WY PPO |
$126.42
|
| Rate for Payer: PacificSource Commercial |
$116.10
|
| Rate for Payer: PHCS PPO |
$126.42
|
| Rate for Payer: Three Rivers PPO |
$96.75
|
| Rate for Payer: TriWest Veterans Administration |
$73.53
|
| Rate for Payer: United Healthcare Commercial |
$123.20
|
| Rate for Payer: United Healthcare Medicare |
$73.53
|
| Rate for Payer: WINHealth Partners Commercial |
$126.42
|
| Rate for Payer: Wise Provider Network Commercial |
$122.55
|
|
|
HC ASSAY OF ZONISAMIDE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
3018020301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.42
|
| Rate for Payer: Aetna of WY Medicare |
$82.56
|
| Rate for Payer: Altius Commercial |
$123.84
|
| Rate for Payer: Beech Street Commercial |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.13
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.13
|
| Rate for Payer: Cigna of WY Commercial |
$126.42
|
| Rate for Payer: Entrust Commercial |
$122.55
|
| Rate for Payer: First Choice Health Commercial |
$122.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$122.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.69
|
| Rate for Payer: HealthUtah PPO |
$129.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.13
|
| Rate for Payer: Multiplan Medicare/VA |
$74.76
|
| Rate for Payer: One Health Plan of WY PPO |
$126.42
|
| Rate for Payer: PacificSource Commercial |
$116.10
|
| Rate for Payer: PHCS PPO |
$126.42
|
| Rate for Payer: Three Rivers PPO |
$96.75
|
| Rate for Payer: TriWest Veterans Administration |
$78.69
|
| Rate for Payer: United Healthcare Commercial |
$123.20
|
| Rate for Payer: United Healthcare Medicare |
$78.69
|
| Rate for Payer: WINHealth Partners Commercial |
$122.55
|
| Rate for Payer: Wise Provider Network Commercial |
$122.55
|
|
|
HC ASSAY ORGANIC ACIDS QUANTITATIVE - ORGANIC ACIDS URINE
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 83918
|
| Hospital Charge Code |
3018391801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Aetna of WY Medicare |
$130.56
|
| Rate for Payer: Altius Commercial |
$195.84
|
| Rate for Payer: Beech Street Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.88
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: Entrust Commercial |
$193.80
|
| Rate for Payer: First Choice Health Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.44
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$118.22
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PHCS PPO |
$199.92
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$124.44
|
| Rate for Payer: United Healthcare Commercial |
$194.82
|
| Rate for Payer: United Healthcare Medicare |
$124.44
|
| Rate for Payer: WINHealth Partners Commercial |
$193.80
|
| Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
|
HC ASSAY ORGANIC ACIDS QUANTITATIVE - ORGANIC ACIDS URINE
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 83918
|
| Hospital Charge Code |
3018391801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.47 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Aetna of WY Medicare |
$134.64
|
| Rate for Payer: Altius Commercial |
$195.84
|
| Rate for Payer: Beech Street Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.88
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: Entrust Commercial |
$193.80
|
| Rate for Payer: First Choice Health Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.28
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$110.47
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PHCS PPO |
$199.92
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.28
|
| Rate for Payer: United Healthcare Commercial |
$194.82
|
| Rate for Payer: United Healthcare Medicare |
$116.28
|
| Rate for Payer: WINHealth Partners Commercial |
$199.92
|
| Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
|
HC ASSAY PHOSPHATASE ACID PROSTATIC - PROSTATIC ACID PHOSPHATASE
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 84066
|
| Hospital Charge Code |
3018406601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC ASSAY PHOSPHATASE ACID PROSTATIC - PROSTATIC ACID PHOSPHATASE
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 84066
|
| Hospital Charge Code |
3018406601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$34.56
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.38
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.94
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$31.29
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$32.94
|
| Rate for Payer: United Healthcare Commercial |
$51.57
|
| Rate for Payer: United Healthcare Medicare |
$32.94
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE RANDOM
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.38
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.78
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.24
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$30.78
|
| Rate for Payer: United Healthcare Commercial |
$51.57
|
| Rate for Payer: United Healthcare Medicare |
$30.78
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$34.56
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.38
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.94
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$31.29
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$32.94
|
| Rate for Payer: United Healthcare Commercial |
$51.57
|
| Rate for Payer: United Healthcare Medicare |
$32.94
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GTT FASTING
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.38
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.78
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.24
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$30.78
|
| Rate for Payer: United Healthcare Commercial |
$51.57
|
| Rate for Payer: United Healthcare Medicare |
$30.78
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC ASSAY RBC PROTOPORPHYRIN - ZINC PROTOPORPHYRIN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 84202
|
| Hospital Charge Code |
3018420202
|
|
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 RBC PROTOPORPHYRIN - ZINC PROTOPORPHYRIN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 84202
|
| Hospital Charge Code |
3018420202
|
|
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, SERUM CHOLINESTERASE - PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
3018248001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$44.22
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.19
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$36.28
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$38.19
|
| Rate for Payer: WINHealth Partners Commercial |
$65.66
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY, SERUM CHOLINESTERASE - PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82480
|
| Hospital Charge Code |
3018248001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$42.88
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.99
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.87
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$38.83
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.87
|
| Rate for Payer: United Healthcare Commercial |
$63.98
|
| Rate for Payer: United Healthcare Medicare |
$40.87
|
| Rate for Payer: WINHealth Partners Commercial |
$63.65
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
3018392101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$224.27 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$247.68
|
| Rate for Payer: Altius Commercial |
$371.52
|
| Rate for Payer: Beech Street Commercial |
$379.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$375.39
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: Entrust Commercial |
$367.65
|
| Rate for Payer: First Choice Health Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$236.07
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$224.27
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$379.26
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$236.07
|
| Rate for Payer: United Healthcare Commercial |
$369.58
|
| Rate for Payer: United Healthcare Medicare |
$236.07
|
| Rate for Payer: WINHealth Partners Commercial |
$367.65
|
| Rate for Payer: Wise Provider Network Commercial |
$367.65
|
|
|
HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
3018392101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$379.26
|
| Rate for Payer: Aetna of WY Medicare |
$255.42
|
| Rate for Payer: Altius Commercial |
$371.52
|
| Rate for Payer: Beech Street Commercial |
$379.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$375.39
|
| Rate for Payer: Cash Price |
$270.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.39
|
| Rate for Payer: Cigna of WY Commercial |
$379.26
|
| Rate for Payer: Entrust Commercial |
$367.65
|
| Rate for Payer: First Choice Health Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.59
|
| Rate for Payer: HealthUtah PPO |
$387.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.39
|
| Rate for Payer: Multiplan Medicare/VA |
$209.56
|
| Rate for Payer: One Health Plan of WY PPO |
$379.26
|
| Rate for Payer: PacificSource Commercial |
$348.30
|
| Rate for Payer: PHCS PPO |
$379.26
|
| Rate for Payer: Three Rivers PPO |
$290.25
|
| Rate for Payer: TriWest Veterans Administration |
$220.59
|
| Rate for Payer: United Healthcare Commercial |
$369.58
|
| Rate for Payer: United Healthcare Medicare |
$220.59
|
| Rate for Payer: WINHealth Partners Commercial |
$379.26
|
| Rate for Payer: Wise Provider Network Commercial |
$367.65
|
|
