|
HC ASSAY OF PARATHORMONE - PTH INTACT
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
3018397001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.33 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Aetna of WY Medicare |
$172.26
|
| Rate for Payer: Altius Commercial |
$250.56
|
| Rate for Payer: Beech Street Commercial |
$255.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.17
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.17
|
| Rate for Payer: Cigna of WY Commercial |
$255.78
|
| Rate for Payer: Entrust Commercial |
$247.95
|
| Rate for Payer: First Choice Health Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.77
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Multiplan Medicare/VA |
$141.33
|
| Rate for Payer: One Health Plan of WY PPO |
$255.78
|
| Rate for Payer: PacificSource Commercial |
$234.90
|
| Rate for Payer: PHCS PPO |
$255.78
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.77
|
| Rate for Payer: United Healthcare Commercial |
$249.26
|
| Rate for Payer: United Healthcare Medicare |
$148.77
|
| Rate for Payer: WINHealth Partners Commercial |
$255.78
|
| Rate for Payer: Wise Provider Network Commercial |
$247.95
|
|
|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$67.84
|
| Rate for Payer: Altius Commercial |
$101.76
|
| Rate for Payer: Beech Street Commercial |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: Entrust Commercial |
$100.70
|
| Rate for Payer: First Choice Health Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.66
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$61.43
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$103.88
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.66
|
| Rate for Payer: United Healthcare Commercial |
$101.23
|
| Rate for Payer: United Healthcare Medicare |
$64.66
|
| Rate for Payer: WINHealth Partners Commercial |
$100.70
|
| Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$69.96
|
| Rate for Payer: Altius Commercial |
$101.76
|
| Rate for Payer: Beech Street Commercial |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: Entrust Commercial |
$100.70
|
| Rate for Payer: First Choice Health Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.42
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$57.40
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$103.88
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.42
|
| Rate for Payer: United Healthcare Commercial |
$101.23
|
| Rate for Payer: United Healthcare Medicare |
$60.42
|
| Rate for Payer: WINHealth Partners Commercial |
$103.88
|
| Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
|
HC ASSAY OF PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
3018018601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| 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 Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.40
|
| 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 |
$68.40
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$64.98
|
| 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 |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$68.40
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
3018018601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$76.80
|
| 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 |
$116.40
|
| 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 |
$73.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$69.54
|
| 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 |
$73.20
|
| Rate for Payer: United Healthcare Commercial |
$114.60
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
3018018502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
3018018502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
HC ASSAY OF PHOSPHORUS INORGANIC URINE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
3018410502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$56.76
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.02
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$46.57
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$49.02
|
| Rate for Payer: United Healthcare Commercial |
$82.13
|
| Rate for Payer: United Healthcare Medicare |
$49.02
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC ASSAY OF PHOSPHORUS INORGANIC URINE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 84105
|
| Hospital Charge Code |
3018410502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$55.04
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.46
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$49.84
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.46
|
| Rate for Payer: United Healthcare Commercial |
$82.13
|
| Rate for Payer: United Healthcare Medicare |
$52.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.70
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC ASSAY OF PORPHOBILINOGEN URINE
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
3018411001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$68.64
|
| Rate for Payer: Altius Commercial |
$99.84
|
| Rate for Payer: Beech Street Commercial |
$101.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: Entrust Commercial |
$98.80
|
| Rate for Payer: First Choice Health Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.28
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$56.32
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$101.92
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$99.32
|
| Rate for Payer: United Healthcare Medicare |
$59.28
|
| Rate for Payer: WINHealth Partners Commercial |
$101.92
|
| Rate for Payer: Wise Provider Network Commercial |
$98.80
|
|
|
HC ASSAY OF PORPHOBILINOGEN URINE
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
3018411001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.92
|
| Rate for Payer: Aetna of WY Medicare |
$66.56
|
| Rate for Payer: Altius Commercial |
$99.84
|
| Rate for Payer: Beech Street Commercial |
$101.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.88
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.88
|
| Rate for Payer: Cigna of WY Commercial |
$101.92
|
| Rate for Payer: Entrust Commercial |
$98.80
|
| Rate for Payer: First Choice Health Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.44
|
| Rate for Payer: HealthUtah PPO |
$104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.88
|
| Rate for Payer: Multiplan Medicare/VA |
$60.27
|
| Rate for Payer: One Health Plan of WY PPO |
$101.92
|
| Rate for Payer: PacificSource Commercial |
$93.60
|
| Rate for Payer: PHCS PPO |
$101.92
|
| Rate for Payer: Three Rivers PPO |
$78.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.44
|
| Rate for Payer: United Healthcare Commercial |
$99.32
|
| Rate for Payer: United Healthcare Medicare |
$63.44
|
| Rate for Payer: WINHealth Partners Commercial |
$98.80
|
| Rate for Payer: Wise Provider Network Commercial |
$98.80
|
|
|
HC ASSAY OF PORPHYRINS FECAL
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 84126
|
| Hospital Charge Code |
3008412601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Medicare |
$223.08
|
| Rate for Payer: Altius Commercial |
$324.48
|
| Rate for Payer: Beech Street Commercial |
$331.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.86
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: Entrust Commercial |
$321.10
|
| Rate for Payer: First Choice Health Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.66
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Multiplan Medicare/VA |
$183.03
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$331.24
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: TriWest Veterans Administration |
$192.66
|
| Rate for Payer: United Healthcare Commercial |
$322.79
|
| Rate for Payer: United Healthcare Medicare |
$192.66
|
| Rate for Payer: WINHealth Partners Commercial |
$331.24
|
| Rate for Payer: Wise Provider Network Commercial |
$321.10
|
|
|
HC ASSAY OF PORPHYRINS FECAL
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 84126
|
| Hospital Charge Code |
3008412601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.87 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.24
|
| Rate for Payer: Aetna of WY Medicare |
$216.32
|
| Rate for Payer: Altius Commercial |
$324.48
|
| Rate for Payer: Beech Street Commercial |
$331.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.86
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$327.86
|
| Rate for Payer: Cigna of WY Commercial |
$331.24
|
| Rate for Payer: Entrust Commercial |
$321.10
|
| Rate for Payer: First Choice Health Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.18
|
| Rate for Payer: HealthUtah PPO |
$338.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$327.86
|
| Rate for Payer: Multiplan Medicare/VA |
$195.87
|
| Rate for Payer: One Health Plan of WY PPO |
$331.24
|
| Rate for Payer: PacificSource Commercial |
$304.20
|
| Rate for Payer: PHCS PPO |
$331.24
|
| Rate for Payer: Three Rivers PPO |
$253.50
|
| Rate for Payer: TriWest Veterans Administration |
$206.18
|
| Rate for Payer: United Healthcare Commercial |
$322.79
|
| Rate for Payer: United Healthcare Medicare |
$206.18
|
| Rate for Payer: WINHealth Partners Commercial |
$321.10
|
| Rate for Payer: Wise Provider Network Commercial |
$321.10
|
|
|
HC ASSAY OF PREALBUMIN - PREALBUMIN
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$81.84
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.68
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$67.15
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.68
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$70.68
|
| Rate for Payer: WINHealth Partners Commercial |
$121.52
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ASSAY OF PREALBUMIN - PREALBUMIN
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.86 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$79.36
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.28
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.64
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$71.86
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$75.64
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: United Healthcare Medicare |
$75.64
|
| Rate for Payer: WINHealth Partners Commercial |
$117.80
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC ASSAY OF PREGNENOLONE - PREGNENOLONE
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
3018414001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.76 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$151.04
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.96
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$136.76
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.96
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$143.96
|
| Rate for Payer: WINHealth Partners Commercial |
$224.20
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
|
HC ASSAY OF PREGNENOLONE - PREGNENOLONE
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
3018414001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.28
|
| Rate for Payer: Aetna of WY Medicare |
$155.76
|
| Rate for Payer: Altius Commercial |
$226.56
|
| Rate for Payer: Beech Street Commercial |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.92
|
| Rate for Payer: Cash Price |
$165.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.92
|
| Rate for Payer: Cigna of WY Commercial |
$231.28
|
| Rate for Payer: Entrust Commercial |
$224.20
|
| Rate for Payer: First Choice Health Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.52
|
| Rate for Payer: HealthUtah PPO |
$236.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.92
|
| Rate for Payer: Multiplan Medicare/VA |
$127.79
|
| Rate for Payer: One Health Plan of WY PPO |
$231.28
|
| Rate for Payer: PacificSource Commercial |
$212.40
|
| Rate for Payer: PHCS PPO |
$231.28
|
| Rate for Payer: Three Rivers PPO |
$177.00
|
| Rate for Payer: TriWest Veterans Administration |
$134.52
|
| Rate for Payer: United Healthcare Commercial |
$225.38
|
| Rate for Payer: United Healthcare Medicare |
$134.52
|
| Rate for Payer: WINHealth Partners Commercial |
$231.28
|
| Rate for Payer: Wise Provider Network Commercial |
$224.20
|
|
|
HC ASSAY OF PRIMIDONE - PRIMIDONE LEVEL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 80188
|
| Hospital Charge Code |
3018018801
|
|
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 PRIMIDONE - PRIMIDONE LEVEL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 80188
|
| Hospital Charge Code |
3018018801
|
|
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
|
|
|
HC ASSAY OF PROCAINAMIDE
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 80190
|
| Hospital Charge Code |
3018019001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$341.88
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.26
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$280.50
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.26
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$295.26
|
| Rate for Payer: WINHealth Partners Commercial |
$507.64
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
HC ASSAY OF PROCAINAMIDE
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 80190
|
| Hospital Charge Code |
3018019001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$507.64
|
| Rate for Payer: Aetna of WY Medicare |
$331.52
|
| Rate for Payer: Altius Commercial |
$497.28
|
| Rate for Payer: Beech Street Commercial |
$507.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$502.46
|
| Rate for Payer: Cash Price |
$362.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$502.46
|
| Rate for Payer: Cigna of WY Commercial |
$507.64
|
| Rate for Payer: Entrust Commercial |
$492.10
|
| Rate for Payer: First Choice Health Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$492.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$315.98
|
| Rate for Payer: HealthUtah PPO |
$518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$502.46
|
| Rate for Payer: Multiplan Medicare/VA |
$300.18
|
| Rate for Payer: One Health Plan of WY PPO |
$507.64
|
| Rate for Payer: PacificSource Commercial |
$466.20
|
| Rate for Payer: PHCS PPO |
$507.64
|
| Rate for Payer: Three Rivers PPO |
$388.50
|
| Rate for Payer: TriWest Veterans Administration |
$315.98
|
| Rate for Payer: United Healthcare Commercial |
$494.69
|
| Rate for Payer: United Healthcare Medicare |
$315.98
|
| Rate for Payer: WINHealth Partners Commercial |
$492.10
|
| Rate for Payer: Wise Provider Network Commercial |
$492.10
|
|
|
HC ASSAY OF PROCAINAMIDE W METABOLITES - PROCAINAMIDE + NAPA
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
3018019201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$92.80
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.45
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$84.03
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$88.45
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF PROCAINAMIDE W METABOLITES - PROCAINAMIDE + NAPA
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
3018019201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$78.52
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.65
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$82.65
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF PROCALCITOUIN
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.60 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$368.48
|
| Rate for Payer: Aetna of WY Medicare |
$248.16
|
| Rate for Payer: Altius Commercial |
$360.96
|
| Rate for Payer: Beech Street Commercial |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$364.72
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$364.72
|
| Rate for Payer: Cigna of WY Commercial |
$368.48
|
| Rate for Payer: Entrust Commercial |
$357.20
|
| Rate for Payer: First Choice Health Commercial |
$357.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$357.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.32
|
| Rate for Payer: HealthUtah PPO |
$376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$364.72
|
| Rate for Payer: Multiplan Medicare/VA |
$203.60
|
| Rate for Payer: One Health Plan of WY PPO |
$368.48
|
| Rate for Payer: PacificSource Commercial |
$338.40
|
| Rate for Payer: PHCS PPO |
$368.48
|
| Rate for Payer: Three Rivers PPO |
$282.00
|
| Rate for Payer: TriWest Veterans Administration |
$214.32
|
| Rate for Payer: United Healthcare Commercial |
$359.08
|
| Rate for Payer: United Healthcare Medicare |
$214.32
|
| Rate for Payer: WINHealth Partners Commercial |
$368.48
|
| Rate for Payer: Wise Provider Network Commercial |
$357.20
|
|
|
HC ASSAY OF PROCALCITOUIN
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$217.89 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$368.48
|
| Rate for Payer: Aetna of WY Medicare |
$240.64
|
| Rate for Payer: Altius Commercial |
$360.96
|
| Rate for Payer: Beech Street Commercial |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$364.72
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$364.72
|
| Rate for Payer: Cigna of WY Commercial |
$368.48
|
| Rate for Payer: Entrust Commercial |
$357.20
|
| Rate for Payer: First Choice Health Commercial |
$357.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$357.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.36
|
| Rate for Payer: HealthUtah PPO |
$376.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$364.72
|
| Rate for Payer: Multiplan Medicare/VA |
$217.89
|
| Rate for Payer: One Health Plan of WY PPO |
$368.48
|
| Rate for Payer: PacificSource Commercial |
$338.40
|
| Rate for Payer: PHCS PPO |
$368.48
|
| Rate for Payer: Three Rivers PPO |
$282.00
|
| Rate for Payer: TriWest Veterans Administration |
$229.36
|
| Rate for Payer: United Healthcare Commercial |
$359.08
|
| Rate for Payer: United Healthcare Medicare |
$229.36
|
| Rate for Payer: WINHealth Partners Commercial |
$357.20
|
| Rate for Payer: Wise Provider Network Commercial |
$357.20
|
|
