|
HC DRUG ASSAY - ACETAMINOPHEN
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
3018014301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Aetna of WY Medicare |
$198.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
| Rate for Payer: Altius Commercial |
$288.00
|
| Rate for Payer: Beech Street Commercial |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: Entrust Commercial |
$285.00
|
| Rate for Payer: First Choice Health Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$165.30
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$294.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: TriWest Veterans Administration |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$174.00
|
| Rate for Payer: WINHealth Partners Commercial |
$294.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC DRUG ASSAY - ADALIMUMAB
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 80145
|
| Hospital Charge Code |
3018014501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC DRUG ASSAY - ADALIMUMAB
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 80145
|
| Hospital Charge Code |
3018014501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC DRUG ASSAY VEDOLIZUMAB
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 80280
|
| Hospital Charge Code |
3018028001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$432.63 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.40
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$432.63
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$455.40
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
| Rate for Payer: WINHealth Partners Commercial |
$655.50
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC DRUG ASSAY VEDOLIZUMAB
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 80280
|
| Hospital Charge Code |
3018028001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$380.19 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$455.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.20
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$380.19
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$400.20
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$400.20
|
| Rate for Payer: WINHealth Partners Commercial |
$676.20
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC DRUG SCREEN
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$896.61 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.80
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$896.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$943.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,358.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC DRUG SCREEN
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$943.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$787.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$829.40
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$829.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - ACETAMINOPHEN
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
3018032902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - ACETAMINOPHEN
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
3018032902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - SALICYLATE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
3018032901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - SALICYLATE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
3018032901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - CLONAZEPAM LEVEL
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - CLONAZEPAM LEVEL
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - FLURAZEPAM LEVEL
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$344.85
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
| Rate for Payer: WINHealth Partners Commercial |
$522.50
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - FLURAZEPAM LEVEL
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$303.05 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$363.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$303.05
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$319.00
|
| Rate for Payer: WINHealth Partners Commercial |
$539.00
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - LORAZEPAM LEVEL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.16 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.90
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$166.16
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$174.90
|
| Rate for Payer: WINHealth Partners Commercial |
$251.75
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - LORAZEPAM LEVEL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Aetna of WY Medicare |
$174.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$254.40
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$217.56
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.70
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$146.02
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.70
|
| Rate for Payer: United Healthcare Commercial |
$230.55
|
| Rate for Payer: United Healthcare Medicare |
$153.70
|
| Rate for Payer: WINHealth Partners Commercial |
$259.70
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - NORFLUNITRAZEPAM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$435.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$633.60
|
| Rate for Payer: Altius Commercial |
$633.60
|
| Rate for Payer: Beech Street Commercial |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.86
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: Entrust Commercial |
$627.00
|
| Rate for Payer: First Choice Health Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$646.80
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.80
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC DRUG SCREENING BENZODIAZEPINES 1-12 - NORFLUNITRAZEPAM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 80346
|
| Hospital Charge Code |
3018034607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$413.82 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$633.60
|
| Rate for Payer: Altius Commercial |
$633.60
|
| Rate for Payer: Beech Street Commercial |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.86
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: Entrust Commercial |
$627.00
|
| Rate for Payer: First Choice Health Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.60
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$413.82
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$646.80
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$435.60
|
| Rate for Payer: WINHealth Partners Commercial |
$627.00
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC DRUG SCREENING KETAMINE - KETAMINE
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 80357
|
| Hospital Charge Code |
3018035701
|
|
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
|
|
|
HC DRUG SCREENING KETAMINE - KETAMINE
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 80357
|
| Hospital Charge Code |
3018035701
|
|
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 DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
3018035801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
3018035801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE, BLOOD
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
3018036103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$162.54 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$194.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.10
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$162.54
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$171.10
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$171.10
|
| Rate for Payer: WINHealth Partners Commercial |
$289.10
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
|
HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE, BLOOD
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
3018036103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$283.20
|
| Rate for Payer: Altius Commercial |
$283.20
|
| Rate for Payer: Beech Street Commercial |
$289.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: Entrust Commercial |
$280.25
|
| Rate for Payer: First Choice Health Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.70
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$184.96
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$289.10
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.70
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$194.70
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
| Rate for Payer: Wise Provider Network Commercial |
$280.25
|
|
