|
HC ASSAY INFLUENZA B BY PCR
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
3068750102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$240.43 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$435.12
|
| Rate for Payer: Aetna of WY Medicare |
$293.04
|
| Rate for Payer: Altius Commercial |
$426.24
|
| Rate for Payer: Beech Street Commercial |
$435.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.68
|
| Rate for Payer: Cigna of WY Commercial |
$435.12
|
| Rate for Payer: Entrust Commercial |
$421.80
|
| Rate for Payer: First Choice Health Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.08
|
| Rate for Payer: HealthUtah PPO |
$444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.68
|
| Rate for Payer: Multiplan Medicare/VA |
$240.43
|
| Rate for Payer: One Health Plan of WY PPO |
$435.12
|
| Rate for Payer: PacificSource Commercial |
$399.60
|
| Rate for Payer: PHCS PPO |
$435.12
|
| Rate for Payer: Three Rivers PPO |
$333.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.08
|
| Rate for Payer: United Healthcare Commercial |
$424.02
|
| Rate for Payer: United Healthcare Medicare |
$253.08
|
| Rate for Payer: WINHealth Partners Commercial |
$435.12
|
| Rate for Payer: Wise Provider Network Commercial |
$421.80
|
|
|
HC ASSAY LACTOFERRIN FECAL QUALITATIVE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
3018363001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Aetna of WY Medicare |
$108.16
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$163.93
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.09
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$97.94
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$103.09
|
| Rate for Payer: United Healthcare Commercial |
$161.40
|
| Rate for Payer: United Healthcare Medicare |
$103.09
|
| Rate for Payer: WINHealth Partners Commercial |
$160.55
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC ASSAY LACTOFERRIN FECAL QUALITATIVE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
3018363001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Aetna of WY Medicare |
$111.54
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$163.93
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.33
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$91.51
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$96.33
|
| Rate for Payer: United Healthcare Commercial |
$161.40
|
| Rate for Payer: United Healthcare Medicare |
$96.33
|
| Rate for Payer: WINHealth Partners Commercial |
$165.62
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
3018369801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$256.64
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.61
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$232.38
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$244.61
|
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: United Healthcare Medicare |
$244.61
|
| Rate for Payer: WINHealth Partners Commercial |
$380.95
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 83698
|
| Hospital Charge Code |
3018369801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$264.66
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.57
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$217.14
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$228.57
|
| Rate for Payer: United Healthcare Medicare |
$228.57
|
| Rate for Payer: WINHealth Partners Commercial |
$392.98
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC ASSAY MYELOPEROXIDASE
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 83876
|
| Hospital Charge Code |
3018387601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.38 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.74
|
| Rate for Payer: Aetna of WY Medicare |
$200.32
|
| Rate for Payer: Altius Commercial |
$300.48
|
| Rate for Payer: Beech Street Commercial |
$306.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.61
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.61
|
| Rate for Payer: Cigna of WY Commercial |
$306.74
|
| Rate for Payer: Entrust Commercial |
$297.35
|
| Rate for Payer: First Choice Health Commercial |
$297.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$297.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.93
|
| Rate for Payer: HealthUtah PPO |
$313.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.61
|
| Rate for Payer: Multiplan Medicare/VA |
$181.38
|
| Rate for Payer: One Health Plan of WY PPO |
$306.74
|
| Rate for Payer: PacificSource Commercial |
$281.70
|
| Rate for Payer: PHCS PPO |
$306.74
|
| Rate for Payer: Three Rivers PPO |
$234.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.93
|
| Rate for Payer: United Healthcare Commercial |
$298.92
|
| Rate for Payer: United Healthcare Medicare |
$190.93
|
| Rate for Payer: WINHealth Partners Commercial |
$297.35
|
| Rate for Payer: Wise Provider Network Commercial |
$297.35
|
|
|
HC ASSAY MYELOPEROXIDASE
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 83876
|
| Hospital Charge Code |
3018387601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$169.49 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.74
|
| Rate for Payer: Aetna of WY Medicare |
$206.58
|
| Rate for Payer: Altius Commercial |
$300.48
|
| Rate for Payer: Beech Street Commercial |
$306.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.61
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.61
|
| Rate for Payer: Cigna of WY Commercial |
$306.74
|
| Rate for Payer: Entrust Commercial |
$297.35
|
| Rate for Payer: First Choice Health Commercial |
$297.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$297.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.41
|
| Rate for Payer: HealthUtah PPO |
$313.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.61
|
| Rate for Payer: Multiplan Medicare/VA |
$169.49
|
| Rate for Payer: One Health Plan of WY PPO |
$306.74
|
| Rate for Payer: PacificSource Commercial |
$281.70
|
| Rate for Payer: PHCS PPO |
$306.74
|
| Rate for Payer: Three Rivers PPO |
$234.75
|
| Rate for Payer: TriWest Veterans Administration |
$178.41
|
| Rate for Payer: United Healthcare Commercial |
$298.92
|
| Rate for Payer: United Healthcare Medicare |
$178.41
|
| Rate for Payer: WINHealth Partners Commercial |
$306.74
|
| Rate for Payer: Wise Provider Network Commercial |
$297.35
|
|
|
HC ASSAY OF 17-HYDROXYPREGNENOLONE - 17-HYDROXYPREGNENOLONE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 84143
|
| Hospital Charge Code |
3018414301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$176.17 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Aetna of WY Medicare |
$194.56
|
| Rate for Payer: Altius Commercial |
$291.84
|
| Rate for Payer: Beech Street Commercial |
$297.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$294.88
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: Entrust Commercial |
$288.80
|
| Rate for Payer: First Choice Health Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.44
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: Multiplan Medicare/VA |
$176.17
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PHCS PPO |
$297.92
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: TriWest Veterans Administration |
$185.44
|
| Rate for Payer: United Healthcare Commercial |
$290.32
|
| Rate for Payer: United Healthcare Medicare |
$185.44
|
| Rate for Payer: WINHealth Partners Commercial |
$288.80
|
| Rate for Payer: Wise Provider Network Commercial |
$288.80
|
|
|
HC ASSAY OF 17-HYDROXYPREGNENOLONE - 17-HYDROXYPREGNENOLONE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 84143
|
| Hospital Charge Code |
3018414301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.62 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$297.92
|
| Rate for Payer: Aetna of WY Medicare |
$200.64
|
| Rate for Payer: Altius Commercial |
$291.84
|
| Rate for Payer: Beech Street Commercial |
$297.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$294.88
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$294.88
|
| Rate for Payer: Cigna of WY Commercial |
$297.92
|
| Rate for Payer: Entrust Commercial |
$288.80
|
| Rate for Payer: First Choice Health Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$288.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$173.28
|
| Rate for Payer: HealthUtah PPO |
$304.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$294.88
|
| Rate for Payer: Multiplan Medicare/VA |
$164.62
|
| Rate for Payer: One Health Plan of WY PPO |
$297.92
|
| Rate for Payer: PacificSource Commercial |
$273.60
|
| Rate for Payer: PHCS PPO |
$297.92
|
| Rate for Payer: Three Rivers PPO |
$228.00
|
| Rate for Payer: TriWest Veterans Administration |
$173.28
|
| Rate for Payer: United Healthcare Commercial |
$290.32
|
| Rate for Payer: United Healthcare Medicare |
$173.28
|
| Rate for Payer: WINHealth Partners Commercial |
$297.92
|
| Rate for Payer: Wise Provider Network Commercial |
$288.80
|
|
|
HC ASSAY OF 5-HIAA - 5 HIAA QUANT,24HR URINE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
3018349701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.52 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$108.80
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.70
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$98.52
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.70
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Medicare |
$103.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ASSAY OF 5-HIAA - 5 HIAA QUANT,24HR URINE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 83497
|
| Hospital Charge Code |
3018349701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.90
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$92.06
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.90
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare Medicare |
$96.90
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ASSAY OF ACTH - ACTH
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
3018202401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.90
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$146.20
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$153.90
|
| Rate for Payer: United Healthcare Commercial |
$257.85
|
| Rate for Payer: United Healthcare Medicare |
$153.90
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC ASSAY OF ACTH - ACTH
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
3018202401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.46 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$172.80
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.70
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$156.46
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$164.70
|
| Rate for Payer: United Healthcare Commercial |
$257.85
|
| Rate for Payer: United Healthcare Medicare |
$164.70
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC ASSAY OF ADP & AMP - CYCLIC AMP, PLASMA
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 82030
|
| Hospital Charge Code |
3018203001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.23 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$142.72
|
| Rate for Payer: Altius Commercial |
$214.08
|
| Rate for Payer: Beech Street Commercial |
$218.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$216.31
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: Entrust Commercial |
$211.85
|
| Rate for Payer: First Choice Health Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.03
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$129.23
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$218.54
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.03
|
| Rate for Payer: United Healthcare Commercial |
$212.96
|
| Rate for Payer: United Healthcare Medicare |
$136.03
|
| Rate for Payer: WINHealth Partners Commercial |
$211.85
|
| Rate for Payer: Wise Provider Network Commercial |
$211.85
|
|
|
HC ASSAY OF ADP & AMP - CYCLIC AMP, PLASMA
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 82030
|
| Hospital Charge Code |
3018203001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$147.18
|
| Rate for Payer: Altius Commercial |
$214.08
|
| Rate for Payer: Beech Street Commercial |
$218.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$216.31
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: Entrust Commercial |
$211.85
|
| Rate for Payer: First Choice Health Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.11
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$120.75
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$218.54
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.11
|
| Rate for Payer: United Healthcare Commercial |
$212.96
|
| Rate for Payer: United Healthcare Medicare |
$127.11
|
| Rate for Payer: WINHealth Partners Commercial |
$218.54
|
| Rate for Payer: Wise Provider Network Commercial |
$211.85
|
|
|
HC ASSAY OF ALDOLASE - ALDOLASE
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
3018208501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Aetna of WY Medicare |
$40.26
|
| Rate for Payer: Altius Commercial |
$58.56
|
| Rate for Payer: Beech Street Commercial |
$59.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.17
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: Entrust Commercial |
$57.95
|
| Rate for Payer: First Choice Health Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.77
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: Multiplan Medicare/VA |
$33.03
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$59.78
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: TriWest Veterans Administration |
$34.77
|
| Rate for Payer: United Healthcare Commercial |
$58.26
|
| Rate for Payer: United Healthcare Medicare |
$34.77
|
| Rate for Payer: WINHealth Partners Commercial |
$59.78
|
| Rate for Payer: Wise Provider Network Commercial |
$57.95
|
|
|
HC ASSAY OF ALDOLASE - ALDOLASE
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
3018208501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Aetna of WY Medicare |
$39.04
|
| Rate for Payer: Altius Commercial |
$58.56
|
| Rate for Payer: Beech Street Commercial |
$59.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.17
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: Entrust Commercial |
$57.95
|
| Rate for Payer: First Choice Health Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.21
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: Multiplan Medicare/VA |
$35.35
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$59.78
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.21
|
| Rate for Payer: United Healthcare Commercial |
$58.26
|
| Rate for Payer: United Healthcare Medicare |
$37.21
|
| Rate for Payer: WINHealth Partners Commercial |
$57.95
|
| Rate for Payer: Wise Provider Network Commercial |
$57.95
|
|
|
HC ASSAY OF ALDOSTERONE - ALDOSTERONE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
3018208802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$146.03 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$161.28
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.72
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$146.03
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$153.72
|
| Rate for Payer: United Healthcare Commercial |
$240.66
|
| Rate for Payer: United Healthcare Medicare |
$153.72
|
| Rate for Payer: WINHealth Partners Commercial |
$239.40
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
HC ASSAY OF ALDOSTERONE - ALDOSTERONE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
3018208802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.46 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$166.32
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.64
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$136.46
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.64
|
| Rate for Payer: United Healthcare Commercial |
$240.66
|
| Rate for Payer: United Healthcare Medicare |
$143.64
|
| Rate for Payer: WINHealth Partners Commercial |
$246.96
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
HC ASSAY OF ALDOSTERONE - ALDOSTERONE, SERUM
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
3018208803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$146.03 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$161.28
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.72
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$146.03
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$153.72
|
| Rate for Payer: United Healthcare Commercial |
$240.66
|
| Rate for Payer: United Healthcare Medicare |
$153.72
|
| Rate for Payer: WINHealth Partners Commercial |
$239.40
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
HC ASSAY OF ALDOSTERONE - ALDOSTERONE, SERUM
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
3018208803
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.46 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$166.32
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$244.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.64
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$136.46
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.64
|
| Rate for Payer: United Healthcare Commercial |
$240.66
|
| Rate for Payer: United Healthcare Medicare |
$143.64
|
| Rate for Payer: WINHealth Partners Commercial |
$246.96
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
HC ASSAY OF ALUMINUM - ALUMINUM LEVEL
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
3018210801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.07 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$141.44
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.81
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$128.07
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$134.81
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$134.81
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC ASSAY OF ALUMINUM - ALUMINUM LEVEL
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
3018210801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.67 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$145.86
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.37
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.97
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$119.67
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.97
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$125.97
|
| Rate for Payer: WINHealth Partners Commercial |
$216.58
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC ASSAY OF AMIKACIN - AMIKACIN PEAK
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
3018015002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC ASSAY OF AMIKACIN - AMIKACIN PEAK
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
3018015002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
