|
HC ASSAY OF URINE SODIUM - SODIUM 24 HOUR URINE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
3018430003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ASSAY OF URINE SODIUM - SODIUM RANDOM URINE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
3018430001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ASSAY OF URINE SODIUM - SODIUM RANDOM URINE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
3018430001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ASSAY OF URINE SULFATE - SULFATE, URINE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 84392
|
| Hospital Charge Code |
3018439201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC ASSAY OF URINE SULFATE - SULFATE, URINE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 84392
|
| Hospital Charge Code |
3018439201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC ASSAY OF URINE VMA - VMA, URINE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
3018458502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC ASSAY OF URINE VMA - VMA, URINE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
3018458502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.58 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$221.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$321.60
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.04
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.30
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$184.58
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.30
|
| Rate for Payer: United Healthcare Commercial |
$291.45
|
| Rate for Payer: United Healthcare Medicare |
$194.30
|
| Rate for Payer: WINHealth Partners Commercial |
$328.30
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$321.60
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.04
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.10
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$210.04
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$221.10
|
| Rate for Payer: United Healthcare Commercial |
$291.45
|
| Rate for Payer: United Healthcare Medicare |
$221.10
|
| Rate for Payer: WINHealth Partners Commercial |
$318.25
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
HC ASSAY OF VENLAFAXINE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
3018033802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC ASSAY OF VENLAFAXINE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
3018033802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Aetna of WY Medicare |
$151.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.40
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$126.73
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$133.40
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$133.40
|
| Rate for Payer: WINHealth Partners Commercial |
$225.40
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.21 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$225.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$220.80
|
| Rate for Payer: Altius Commercial |
$220.80
|
| Rate for Payer: Beech Street Commercial |
$225.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.83
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$223.10
|
| Rate for Payer: Cigna of WY Commercial |
$225.40
|
| Rate for Payer: Entrust Commercial |
$218.50
|
| Rate for Payer: First Choice Health Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$218.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.80
|
| Rate for Payer: HealthUtah PPO |
$230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$223.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.21
|
| Rate for Payer: One Health Plan of WY PPO |
$225.40
|
| Rate for Payer: PacificSource Commercial |
$207.00
|
| Rate for Payer: PHCS PPO |
$225.40
|
| Rate for Payer: Three Rivers PPO |
$172.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.80
|
| Rate for Payer: United Healthcare Commercial |
$200.10
|
| Rate for Payer: United Healthcare Medicare |
$151.80
|
| Rate for Payer: WINHealth Partners Commercial |
$218.50
|
| Rate for Payer: Wise Provider Network Commercial |
$218.50
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
3018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
3018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC ASSAY OF VITAMIN B-2 - VITAMIN B2
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
3018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$235.12 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$235.12
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$247.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$247.50
|
| Rate for Payer: WINHealth Partners Commercial |
$356.25
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
|
HC ASSAY OF VITAMIN B-2 - VITAMIN B2
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
3018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$206.62 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$367.50
|
| Rate for Payer: Aetna of WY Medicare |
$247.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$360.00
|
| Rate for Payer: Altius Commercial |
$360.00
|
| Rate for Payer: Beech Street Commercial |
$367.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.75
|
| Rate for Payer: Cigna of WY Commercial |
$367.50
|
| Rate for Payer: Entrust Commercial |
$356.25
|
| Rate for Payer: First Choice Health Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$356.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.50
|
| Rate for Payer: HealthUtah PPO |
$375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.75
|
| Rate for Payer: Multiplan Medicare/VA |
$206.62
|
| Rate for Payer: One Health Plan of WY PPO |
$367.50
|
| Rate for Payer: PacificSource Commercial |
$337.50
|
| Rate for Payer: PHCS PPO |
$367.50
|
| Rate for Payer: Three Rivers PPO |
$281.25
|
| Rate for Payer: TriWest Veterans Administration |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$326.25
|
| Rate for Payer: United Healthcare Medicare |
$217.50
|
| Rate for Payer: WINHealth Partners Commercial |
$367.50
|
| Rate for Payer: Wise Provider Network Commercial |
$356.25
|
|
