|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG SERUM
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.90 |
| 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 Auto/Workers Compensation |
$139.20
|
| 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 |
$119.04
|
| 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 |
$84.10
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$79.90
|
| 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 |
$84.10
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$84.10
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG SERUM
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| 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 |
$119.04
|
| 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 |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| 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 |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.20
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$137.94
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$145.20
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$145.20
|
| Rate for Payer: WINHealth Partners Commercial |
$209.00
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$215.60
|
| Rate for Payer: Aetna of WY Medicare |
$145.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.20
|
| Rate for Payer: Altius Commercial |
$211.20
|
| Rate for Payer: Beech Street Commercial |
$215.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$180.62
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$213.40
|
| Rate for Payer: Cigna of WY Commercial |
$215.60
|
| Rate for Payer: Entrust Commercial |
$209.00
|
| Rate for Payer: First Choice Health Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.60
|
| Rate for Payer: HealthUtah PPO |
$220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$213.40
|
| Rate for Payer: Multiplan Medicare/VA |
$121.22
|
| Rate for Payer: One Health Plan of WY PPO |
$215.60
|
| Rate for Payer: PacificSource Commercial |
$198.00
|
| Rate for Payer: PHCS PPO |
$215.60
|
| Rate for Payer: Three Rivers PPO |
$165.00
|
| Rate for Payer: TriWest Veterans Administration |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$191.40
|
| Rate for Payer: United Healthcare Medicare |
$127.60
|
| Rate for Payer: WINHealth Partners Commercial |
$215.60
|
| Rate for Payer: Wise Provider Network Commercial |
$209.00
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
3018278501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
3018278501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ASSAY OF GASTRIN - GASTRIN
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
3018294101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY OF GASTRIN - GASTRIN
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
3018294101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ASSAY OF GGT - GAMMA GT
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3018297701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.59 |
| 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 Auto/Workers Compensation |
$86.40
|
| 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 |
$73.89
|
| 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 |
$52.20
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$49.59
|
| 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 |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$52.20
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF GGT - GAMMA GT
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3018297701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| 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 |
$73.89
|
| 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 |
$59.40
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.43
|
| 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 |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3018301001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3018301001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC ASSAY OF HISTAMINE - HISTAMINE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
3018308801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC ASSAY OF HISTAMINE - HISTAMINE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
3018308801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
3018309002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Aetna of WY Medicare |
$102.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.90
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$85.40
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$89.90
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: WINHealth Partners Commercial |
$151.90
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
3018309002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.80
|
| Rate for Payer: Altius Commercial |
$148.80
|
| Rate for Payer: Beech Street Commercial |
$151.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$150.35
|
| Rate for Payer: Cigna of WY Commercial |
$151.90
|
| Rate for Payer: Entrust Commercial |
$147.25
|
| Rate for Payer: First Choice Health Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$147.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.30
|
| Rate for Payer: HealthUtah PPO |
$155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$150.35
|
| Rate for Payer: Multiplan Medicare/VA |
$97.18
|
| Rate for Payer: One Health Plan of WY PPO |
$151.90
|
| Rate for Payer: PacificSource Commercial |
$139.50
|
| Rate for Payer: PHCS PPO |
$151.90
|
| Rate for Payer: Three Rivers PPO |
$116.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.30
|
| Rate for Payer: United Healthcare Commercial |
$134.85
|
| Rate for Payer: United Healthcare Medicare |
$102.30
|
| Rate for Payer: WINHealth Partners Commercial |
$147.25
|
| Rate for Payer: Wise Provider Network Commercial |
$147.25
|
|
|
HC ASSAY OF INFLIXIMAB
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
3018023001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC ASSAY OF INFLIXIMAB
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
3018023001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
3018410004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
