|
HC ASSAY OF SERUM POTASSIUM - POTASSIUM
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3018413201
|
|
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 SERUM SODIUM - SODIUM
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
3018429501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC ASSAY OF SERUM SODIUM - SODIUM
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
3018429501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
3018427001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$76.16
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.43
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.59
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$68.96
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$72.59
|
| Rate for Payer: United Healthcare Commercial |
$113.64
|
| Rate for Payer: United Healthcare Medicare |
$72.59
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
3018427001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.44 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.43
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.83
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$64.44
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.83
|
| Rate for Payer: United Healthcare Commercial |
$113.64
|
| Rate for Payer: United Healthcare Medicare |
$67.83
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC ASSAY OF SIROLIMUS - SIROLIMUS/RAPAMUNE
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
3018019501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.80 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Aetna of WY Medicare |
$124.08
|
| Rate for Payer: Altius Commercial |
$180.48
|
| Rate for Payer: Beech Street Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$182.36
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: Entrust Commercial |
$178.60
|
| Rate for Payer: First Choice Health Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.16
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: Multiplan Medicare/VA |
$101.80
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$184.24
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.16
|
| Rate for Payer: United Healthcare Commercial |
$179.54
|
| Rate for Payer: United Healthcare Medicare |
$107.16
|
| Rate for Payer: WINHealth Partners Commercial |
$184.24
|
| Rate for Payer: Wise Provider Network Commercial |
$178.60
|
|
|
HC ASSAY OF SIROLIMUS - SIROLIMUS/RAPAMUNE
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
3018019501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Aetna of WY Medicare |
$120.32
|
| Rate for Payer: Altius Commercial |
$180.48
|
| Rate for Payer: Beech Street Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$182.36
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: Entrust Commercial |
$178.60
|
| Rate for Payer: First Choice Health Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.68
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: Multiplan Medicare/VA |
$108.95
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$184.24
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: TriWest Veterans Administration |
$114.68
|
| Rate for Payer: United Healthcare Commercial |
$179.54
|
| Rate for Payer: United Healthcare Medicare |
$114.68
|
| Rate for Payer: WINHealth Partners Commercial |
$178.60
|
| Rate for Payer: Wise Provider Network Commercial |
$178.60
|
|
|
HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
3018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.10 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$177.92
|
| Rate for Payer: Altius Commercial |
$266.88
|
| Rate for Payer: Beech Street Commercial |
$272.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.66
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: Entrust Commercial |
$264.10
|
| Rate for Payer: First Choice Health Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.58
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$161.10
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$272.44
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$169.58
|
| Rate for Payer: United Healthcare Commercial |
$265.49
|
| Rate for Payer: United Healthcare Medicare |
$169.58
|
| Rate for Payer: WINHealth Partners Commercial |
$264.10
|
| Rate for Payer: Wise Provider Network Commercial |
$264.10
|
|
|
HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
3018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$183.48
|
| Rate for Payer: Altius Commercial |
$266.88
|
| Rate for Payer: Beech Street Commercial |
$272.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.66
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: Entrust Commercial |
$264.10
|
| Rate for Payer: First Choice Health Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.46
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$150.54
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$272.44
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$158.46
|
| Rate for Payer: United Healthcare Commercial |
$265.49
|
| Rate for Payer: United Healthcare Medicare |
$158.46
|
| Rate for Payer: WINHealth Partners Commercial |
$272.44
|
| Rate for Payer: Wise Provider Network Commercial |
$264.10
|
|
|
HC ASSAY OF TACROLIMUS - TACROLIMUS
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
3018019701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$122.88
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.12
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$111.26
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.12
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$117.12
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC ASSAY OF TACROLIMUS - TACROLIMUS
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
3018019701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$126.72
|
| Rate for Payer: Altius Commercial |
$184.32
|
| Rate for Payer: Beech Street Commercial |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: Entrust Commercial |
$182.40
|
| Rate for Payer: First Choice Health Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.44
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$103.97
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$188.16
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.44
|
| Rate for Payer: United Healthcare Commercial |
$183.36
|
| Rate for Payer: United Healthcare Medicare |
$109.44
|
| Rate for Payer: WINHealth Partners Commercial |
$188.16
|
| Rate for Payer: Wise Provider Network Commercial |
$182.40
|
|
|
HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
3018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.18 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$106.26
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.17
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.77
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$87.18
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$91.77
|
| Rate for Payer: United Healthcare Commercial |
$153.76
|
| Rate for Payer: United Healthcare Medicare |
$91.77
|
| Rate for Payer: WINHealth Partners Commercial |
$157.78
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
3018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.30 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$103.04
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.17
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.21
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$93.30
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.21
|
| Rate for Payer: United Healthcare Commercial |
$153.76
|
| Rate for Payer: United Healthcare Medicare |
$98.21
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC ASSAY OF TESTOSTERONE TOTAL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
3008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Aetna of WY Medicare |
$77.88
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.46
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.26
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$63.90
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.26
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$67.26
|
| Rate for Payer: WINHealth Partners Commercial |
$115.64
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY OF TESTOSTERONE TOTAL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
3008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.64
|
| Rate for Payer: Aetna of WY Medicare |
$75.52
|
| Rate for Payer: Altius Commercial |
$113.28
|
| Rate for Payer: Beech Street Commercial |
$115.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.46
|
| Rate for Payer: Cash Price |
$82.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.46
|
| Rate for Payer: Cigna of WY Commercial |
$115.64
|
| Rate for Payer: Entrust Commercial |
$112.10
|
| Rate for Payer: First Choice Health Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$112.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.98
|
| Rate for Payer: HealthUtah PPO |
$118.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.46
|
| Rate for Payer: Multiplan Medicare/VA |
$68.38
|
| Rate for Payer: One Health Plan of WY PPO |
$115.64
|
| Rate for Payer: PacificSource Commercial |
$106.20
|
| Rate for Payer: PHCS PPO |
$115.64
|
| Rate for Payer: Three Rivers PPO |
$88.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.98
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$71.98
|
| Rate for Payer: WINHealth Partners Commercial |
$112.10
|
| Rate for Payer: Wise Provider Network Commercial |
$112.10
|
|
|
HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 80198
|
| Hospital Charge Code |
3018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.54
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$66.06
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$69.54
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$69.54
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC ASSAY OF THEOPHYLLINE - THEOPHYLLINE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 80198
|
| Hospital Charge Code |
3018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$78.08
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.34
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.42
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$70.70
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$116.51
|
| Rate for Payer: United Healthcare Medicare |
$74.42
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC ASSAY OF THIOCYANATE - THIOCYANATE, URINE, 24 HOUR
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 84430
|
| Hospital Charge Code |
3018443002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$64.64
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.97
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.61
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$58.53
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.61
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$61.61
|
| Rate for Payer: WINHealth Partners Commercial |
$95.95
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC ASSAY OF THIOCYANATE - THIOCYANATE, URINE, 24 HOUR
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 84430
|
| Hospital Charge Code |
3018443002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.69 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$66.66
|
| Rate for Payer: Altius Commercial |
$96.96
|
| Rate for Payer: Beech Street Commercial |
$98.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.97
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: Entrust Commercial |
$95.95
|
| Rate for Payer: First Choice Health Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.57
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$54.69
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$98.98
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$57.57
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$57.57
|
| Rate for Payer: WINHealth Partners Commercial |
$98.98
|
| Rate for Payer: Wise Provider Network Commercial |
$95.95
|
|
|
HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
3018443201
|
|
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 THYROGLOBULIN - THYROGLOBULIN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
3018443201
|
|
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 THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
3018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$211.20
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.40
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.40
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$173.28
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.40
|
| Rate for Payer: United Healthcare Commercial |
$305.60
|
| Rate for Payer: United Healthcare Medicare |
$182.40
|
| Rate for Payer: WINHealth Partners Commercial |
$313.60
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
3018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$185.44 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$313.60
|
| Rate for Payer: Aetna of WY Medicare |
$204.80
|
| Rate for Payer: Altius Commercial |
$307.20
|
| Rate for Payer: Beech Street Commercial |
$313.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.40
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$310.40
|
| Rate for Payer: Cigna of WY Commercial |
$313.60
|
| Rate for Payer: Entrust Commercial |
$304.00
|
| Rate for Payer: First Choice Health Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.20
|
| Rate for Payer: HealthUtah PPO |
$320.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$310.40
|
| Rate for Payer: Multiplan Medicare/VA |
$185.44
|
| Rate for Payer: One Health Plan of WY PPO |
$313.60
|
| Rate for Payer: PacificSource Commercial |
$288.00
|
| Rate for Payer: PHCS PPO |
$313.60
|
| Rate for Payer: Three Rivers PPO |
$240.00
|
| Rate for Payer: TriWest Veterans Administration |
$195.20
|
| Rate for Payer: United Healthcare Commercial |
$305.60
|
| Rate for Payer: United Healthcare Medicare |
$195.20
|
| Rate for Payer: WINHealth Partners Commercial |
$304.00
|
| Rate for Payer: Wise Provider Network Commercial |
$304.00
|
|
|
HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
3018444201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.90 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Aetna of WY Medicare |
$184.32
|
| Rate for Payer: Altius Commercial |
$276.48
|
| Rate for Payer: Beech Street Commercial |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.36
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: Entrust Commercial |
$273.60
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.68
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: Multiplan Medicare/VA |
$166.90
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$282.24
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: TriWest Veterans Administration |
$175.68
|
| Rate for Payer: United Healthcare Commercial |
$275.04
|
| Rate for Payer: United Healthcare Medicare |
$175.68
|
| Rate for Payer: WINHealth Partners Commercial |
$273.60
|
| Rate for Payer: Wise Provider Network Commercial |
$273.60
|
|
|
HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
3018444201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$155.95 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Aetna of WY Medicare |
$190.08
|
| Rate for Payer: Altius Commercial |
$276.48
|
| Rate for Payer: Beech Street Commercial |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.36
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: Entrust Commercial |
$273.60
|
| Rate for Payer: First Choice Health Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.16
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: Multiplan Medicare/VA |
$155.95
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$282.24
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: TriWest Veterans Administration |
$164.16
|
| Rate for Payer: United Healthcare Commercial |
$275.04
|
| Rate for Payer: United Healthcare Medicare |
$164.16
|
| Rate for Payer: WINHealth Partners Commercial |
$282.24
|
| Rate for Payer: Wise Provider Network Commercial |
$273.60
|
|
