|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG SERUM
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.97 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.24
|
| Rate for Payer: Aetna of WY Medicare |
$88.32
|
| Rate for Payer: Altius Commercial |
$132.48
|
| Rate for Payer: Beech Street Commercial |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.86
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.86
|
| Rate for Payer: Cigna of WY Commercial |
$135.24
|
| Rate for Payer: Entrust Commercial |
$131.10
|
| Rate for Payer: First Choice Health Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.18
|
| Rate for Payer: HealthUtah PPO |
$138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.86
|
| Rate for Payer: Multiplan Medicare/VA |
$79.97
|
| Rate for Payer: One Health Plan of WY PPO |
$135.24
|
| Rate for Payer: PacificSource Commercial |
$124.20
|
| Rate for Payer: PHCS PPO |
$135.24
|
| Rate for Payer: Three Rivers PPO |
$103.50
|
| Rate for Payer: TriWest Veterans Administration |
$84.18
|
| Rate for Payer: United Healthcare Commercial |
$131.79
|
| Rate for Payer: United Healthcare Medicare |
$84.18
|
| Rate for Payer: WINHealth Partners Commercial |
$131.10
|
| Rate for Payer: Wise Provider Network Commercial |
$131.10
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$135.68
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.32
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$122.85
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.32
|
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: United Healthcare Medicare |
$129.32
|
| Rate for Payer: WINHealth Partners Commercial |
$201.40
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.76
|
| Rate for Payer: Aetna of WY Medicare |
$139.92
|
| Rate for Payer: Altius Commercial |
$203.52
|
| Rate for Payer: Beech Street Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.64
|
| Rate for Payer: Cash Price |
$148.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.64
|
| Rate for Payer: Cigna of WY Commercial |
$207.76
|
| Rate for Payer: Entrust Commercial |
$201.40
|
| Rate for Payer: First Choice Health Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$201.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.84
|
| Rate for Payer: HealthUtah PPO |
$212.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.64
|
| Rate for Payer: Multiplan Medicare/VA |
$114.80
|
| Rate for Payer: One Health Plan of WY PPO |
$207.76
|
| Rate for Payer: PacificSource Commercial |
$190.80
|
| Rate for Payer: PHCS PPO |
$207.76
|
| Rate for Payer: Three Rivers PPO |
$159.00
|
| Rate for Payer: TriWest Veterans Administration |
$120.84
|
| Rate for Payer: United Healthcare Commercial |
$202.46
|
| Rate for Payer: United Healthcare Medicare |
$120.84
|
| Rate for Payer: WINHealth Partners Commercial |
$207.76
|
| Rate for Payer: Wise Provider Network Commercial |
$201.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$60.72
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.44
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.82
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.44
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$52.44
|
| Rate for Payer: WINHealth Partners Commercial |
$90.16
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
3018278401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.31 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.88
|
| Rate for Payer: Altius Commercial |
$88.32
|
| Rate for Payer: Beech Street Commercial |
$90.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: Entrust Commercial |
$87.40
|
| Rate for Payer: First Choice Health Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.12
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$53.31
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$90.16
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.12
|
| Rate for Payer: United Healthcare Commercial |
$87.86
|
| Rate for Payer: United Healthcare Medicare |
$56.12
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
| Rate for Payer: Wise Provider Network Commercial |
$87.40
|
|
|
HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
3018278501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$149.00 |
| 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 Commercial |
$142.30
|
| 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 GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
3018278501
|
|
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 GASTRIN - GASTRIN
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
3018294101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$73.26
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.27
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$60.11
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$63.27
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WINHealth Partners Commercial |
$108.78
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC ASSAY OF GASTRIN - GASTRIN
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
3018294101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$71.04
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.71
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$64.32
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.71
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$67.71
|
| Rate for Payer: WINHealth Partners Commercial |
$105.45
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$99.84
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.16
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$90.40
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.16
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$95.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.92
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$84.47
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.92
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$88.92
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$99.84
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.16
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$90.40
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.16
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$95.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.32
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.92
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$84.47
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.92
|
| Rate for Payer: United Healthcare Commercial |
$148.98
|
| Rate for Payer: United Healthcare Medicare |
$88.92
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC ASSAY OF GGT - GAMMA GT
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3018297701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$53.46
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.57
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.17
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$43.86
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.17
|
| Rate for Payer: United Healthcare Commercial |
$77.36
|
| Rate for Payer: United Healthcare Medicare |
$46.17
|
| Rate for Payer: WINHealth Partners Commercial |
$79.38
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC ASSAY OF GGT - GAMMA GT
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
3018297701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$51.84
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.57
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.41
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$46.94
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.41
|
| Rate for Payer: United Healthcare Commercial |
$77.36
|
| Rate for Payer: United Healthcare Medicare |
$49.41
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3018301001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$89.10
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.95
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$73.10
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$76.95
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$76.95
|
| Rate for Payer: WINHealth Partners Commercial |
$132.30
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC ASSAY OF HAPTOGLOBIN, QUANT - HAPTOGLOBIN
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
3018301001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$86.40
|
| Rate for Payer: Altius Commercial |
$129.60
|
| Rate for Payer: Beech Street Commercial |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: Entrust Commercial |
$128.25
|
| Rate for Payer: First Choice Health Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.35
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$78.23
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$132.30
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$128.92
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
| Rate for Payer: WINHealth Partners Commercial |
$128.25
|
| Rate for Payer: Wise Provider Network Commercial |
$128.25
|
|
|
HC ASSAY OF HISTAMINE - HISTAMINE
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
3018308801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Aetna of WY Medicare |
$131.20
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.85
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.05
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$118.80
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.05
|
| Rate for Payer: United Healthcare Commercial |
$195.78
|
| Rate for Payer: United Healthcare Medicare |
$125.05
|
| Rate for Payer: WINHealth Partners Commercial |
$194.75
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC ASSAY OF HISTAMINE - HISTAMINE
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 83088
|
| Hospital Charge Code |
3018308801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.90
|
| Rate for Payer: Aetna of WY Medicare |
$135.30
|
| Rate for Payer: Altius Commercial |
$196.80
|
| Rate for Payer: Beech Street Commercial |
$200.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$198.85
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.85
|
| Rate for Payer: Cigna of WY Commercial |
$200.90
|
| Rate for Payer: Entrust Commercial |
$194.75
|
| Rate for Payer: First Choice Health Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.85
|
| Rate for Payer: HealthUtah PPO |
$205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.85
|
| Rate for Payer: Multiplan Medicare/VA |
$111.01
|
| Rate for Payer: One Health Plan of WY PPO |
$200.90
|
| Rate for Payer: PacificSource Commercial |
$184.50
|
| Rate for Payer: PHCS PPO |
$200.90
|
| Rate for Payer: Three Rivers PPO |
$153.75
|
| Rate for Payer: TriWest Veterans Administration |
$116.85
|
| Rate for Payer: United Healthcare Commercial |
$195.78
|
| Rate for Payer: United Healthcare Medicare |
$116.85
|
| Rate for Payer: WINHealth Partners Commercial |
$200.90
|
| Rate for Payer: Wise Provider Network Commercial |
$194.75
|
|
|
HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
3018309002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.50
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$81.22
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$143.25
|
| Rate for Payer: United Healthcare Medicare |
$85.50
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
3018309002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.92 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$96.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.50
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$86.92
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$91.50
|
| Rate for Payer: United Healthcare Commercial |
$143.25
|
| Rate for Payer: United Healthcare Medicare |
$91.50
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC ASSAY OF INFLIXIMAB
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
3018023001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$301.92 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$510.58
|
| Rate for Payer: Aetna of WY Medicare |
$333.44
|
| Rate for Payer: Altius Commercial |
$500.16
|
| Rate for Payer: Beech Street Commercial |
$510.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$505.37
|
| Rate for Payer: Cash Price |
$364.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$505.37
|
| Rate for Payer: Cigna of WY Commercial |
$510.58
|
| Rate for Payer: Entrust Commercial |
$494.95
|
| Rate for Payer: First Choice Health Commercial |
$494.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.81
|
| Rate for Payer: HealthUtah PPO |
$521.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$505.37
|
| Rate for Payer: Multiplan Medicare/VA |
$301.92
|
| Rate for Payer: One Health Plan of WY PPO |
$510.58
|
| Rate for Payer: PacificSource Commercial |
$468.90
|
| Rate for Payer: PHCS PPO |
$510.58
|
| Rate for Payer: Three Rivers PPO |
$390.75
|
| Rate for Payer: TriWest Veterans Administration |
$317.81
|
| Rate for Payer: United Healthcare Commercial |
$497.56
|
| Rate for Payer: United Healthcare Medicare |
$317.81
|
| Rate for Payer: WINHealth Partners Commercial |
$494.95
|
| Rate for Payer: Wise Provider Network Commercial |
$494.95
|
|
|
HC ASSAY OF INFLIXIMAB
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
3018023001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$282.12 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$510.58
|
| Rate for Payer: Aetna of WY Medicare |
$343.86
|
| Rate for Payer: Altius Commercial |
$500.16
|
| Rate for Payer: Beech Street Commercial |
$510.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$505.37
|
| Rate for Payer: Cash Price |
$364.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$505.37
|
| Rate for Payer: Cigna of WY Commercial |
$510.58
|
| Rate for Payer: Entrust Commercial |
$494.95
|
| Rate for Payer: First Choice Health Commercial |
$494.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$296.97
|
| Rate for Payer: HealthUtah PPO |
$521.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$505.37
|
| Rate for Payer: Multiplan Medicare/VA |
$282.12
|
| Rate for Payer: One Health Plan of WY PPO |
$510.58
|
| Rate for Payer: PacificSource Commercial |
$468.90
|
| Rate for Payer: PHCS PPO |
$510.58
|
| Rate for Payer: Three Rivers PPO |
$390.75
|
| Rate for Payer: TriWest Veterans Administration |
$296.97
|
| Rate for Payer: United Healthcare Commercial |
$497.56
|
| Rate for Payer: United Healthcare Medicare |
$296.97
|
| Rate for Payer: WINHealth Partners Commercial |
$510.58
|
| Rate for Payer: Wise Provider Network Commercial |
$494.95
|
|
|
HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
3018410004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Medicare |
$74.88
|
| Rate for Payer: Altius Commercial |
$112.32
|
| Rate for Payer: Beech Street Commercial |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.49
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: Entrust Commercial |
$111.15
|
| Rate for Payer: First Choice Health Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.37
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$67.80
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$114.66
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.37
|
| Rate for Payer: United Healthcare Commercial |
$111.74
|
| Rate for Payer: United Healthcare Medicare |
$71.37
|
| Rate for Payer: WINHealth Partners Commercial |
$111.15
|
| Rate for Payer: Wise Provider Network Commercial |
$111.15
|
|
|
HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
3018410004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Medicare |
$77.22
|
| Rate for Payer: Altius Commercial |
$112.32
|
| Rate for Payer: Beech Street Commercial |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.49
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: Entrust Commercial |
$111.15
|
| Rate for Payer: First Choice Health Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.69
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$114.66
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$66.69
|
| Rate for Payer: United Healthcare Commercial |
$111.74
|
| Rate for Payer: United Healthcare Medicare |
$66.69
|
| Rate for Payer: WINHealth Partners Commercial |
$114.66
|
| Rate for Payer: Wise Provider Network Commercial |
$111.15
|
|
