|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN PEAK
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$174.90 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$213.18
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$313.31
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.11
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$174.90
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$184.11
|
| Rate for Payer: United Healthcare Commercial |
$308.46
|
| Rate for Payer: United Healthcare Medicare |
$184.11
|
| Rate for Payer: WINHealth Partners Commercial |
$316.54
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$206.72
|
| Rate for Payer: Altius Commercial |
$310.08
|
| Rate for Payer: Beech Street Commercial |
$316.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$313.31
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: Entrust Commercial |
$306.85
|
| Rate for Payer: First Choice Health Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.03
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$187.18
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$316.54
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$197.03
|
| Rate for Payer: United Healthcare Commercial |
$308.46
|
| Rate for Payer: United Healthcare Medicare |
$197.03
|
| Rate for Payer: WINHealth Partners Commercial |
$306.85
|
| Rate for Payer: Wise Provider Network Commercial |
$306.85
|
|
|
HC ASSAY OF VENLAFAXINE
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
3018033802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$172.16
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.09
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$155.89
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$164.09
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$164.09
|
| Rate for Payer: WINHealth Partners Commercial |
$255.55
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC ASSAY OF VENLAFAXINE
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
3018033802
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$145.66 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$177.54
|
| Rate for Payer: Altius Commercial |
$258.24
|
| Rate for Payer: Beech Street Commercial |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.93
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: Entrust Commercial |
$255.55
|
| Rate for Payer: First Choice Health Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.33
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$145.66
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$263.62
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.33
|
| Rate for Payer: United Healthcare Commercial |
$256.90
|
| Rate for Payer: United Healthcare Medicare |
$153.33
|
| Rate for Payer: WINHealth Partners Commercial |
$263.62
|
| Rate for Payer: Wise Provider Network Commercial |
$255.55
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$147.18
|
| Rate for Payer: Altius Commercial |
$214.08
|
| Rate for Payer: Beech Street Commercial |
$218.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$216.31
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: Entrust Commercial |
$211.85
|
| Rate for Payer: First Choice Health Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.11
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$120.75
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$218.54
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.11
|
| Rate for Payer: United Healthcare Commercial |
$212.96
|
| Rate for Payer: United Healthcare Medicare |
$127.11
|
| Rate for Payer: WINHealth Partners Commercial |
$218.54
|
| Rate for Payer: Wise Provider Network Commercial |
$211.85
|
|
|
HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3018458601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.23 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$142.72
|
| Rate for Payer: Altius Commercial |
$214.08
|
| Rate for Payer: Beech Street Commercial |
$218.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$216.31
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: Entrust Commercial |
$211.85
|
| Rate for Payer: First Choice Health Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.03
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$129.23
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$218.54
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.03
|
| Rate for Payer: United Healthcare Commercial |
$212.96
|
| Rate for Payer: United Healthcare Medicare |
$136.03
|
| Rate for Payer: WINHealth Partners Commercial |
$211.85
|
| Rate for Payer: Wise Provider Network Commercial |
$211.85
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
3018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.09 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$109.44
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.31
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$99.09
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$104.31
|
| Rate for Payer: WINHealth Partners Commercial |
$162.45
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC ASSAY OF VITAMIN A - VITAMIN A
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
3018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$112.86
|
| Rate for Payer: Altius Commercial |
$164.16
|
| Rate for Payer: Beech Street Commercial |
$167.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.87
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: Entrust Commercial |
$162.45
|
| Rate for Payer: First Choice Health Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.47
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$92.60
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$167.58
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.47
|
| Rate for Payer: United Healthcare Commercial |
$163.30
|
| Rate for Payer: United Healthcare Medicare |
$97.47
|
| Rate for Payer: WINHealth Partners Commercial |
$167.58
|
| Rate for Payer: Wise Provider Network Commercial |
$162.45
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$138.88
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.49
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.37
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$125.75
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.37
|
| Rate for Payer: United Healthcare Commercial |
$207.24
|
| Rate for Payer: United Healthcare Medicare |
$132.37
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.51 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.49
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.69
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$117.51
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$123.69
|
| Rate for Payer: United Healthcare Commercial |
$207.24
|
| Rate for Payer: United Healthcare Medicare |
$123.69
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC ASSAY OF VITAMIN B-2 - VITAMIN B2
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
3018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$232.96
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.04
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$210.94
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$222.04
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$222.04
|
| Rate for Payer: WINHealth Partners Commercial |
$345.80
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
HC ASSAY OF VITAMIN B-2 - VITAMIN B2
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
3018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$240.24
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.48
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$197.11
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$207.48
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$207.48
|
| Rate for Payer: WINHealth Partners Commercial |
$356.72
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
HC ASSAY OF VITAMIN B-6 - VITAMIN B6
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
3018420701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Aetna of WY Medicare |
$160.38
|
| Rate for Payer: Altius Commercial |
$233.28
|
| Rate for Payer: Beech Street Commercial |
$238.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$235.71
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: Entrust Commercial |
$230.85
|
| Rate for Payer: First Choice Health Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.51
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: Multiplan Medicare/VA |
$131.58
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$238.14
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: TriWest Veterans Administration |
$138.51
|
| Rate for Payer: United Healthcare Commercial |
$232.06
|
| Rate for Payer: United Healthcare Medicare |
$138.51
|
| Rate for Payer: WINHealth Partners Commercial |
$238.14
|
| Rate for Payer: Wise Provider Network Commercial |
$230.85
|
|
|
HC ASSAY OF VITAMIN B-6 - VITAMIN B6
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
3018420701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Aetna of WY Medicare |
$155.52
|
| Rate for Payer: Altius Commercial |
$233.28
|
| Rate for Payer: Beech Street Commercial |
$238.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$235.71
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: Entrust Commercial |
$230.85
|
| Rate for Payer: First Choice Health Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.23
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: Multiplan Medicare/VA |
$140.82
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$238.14
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: TriWest Veterans Administration |
$148.23
|
| Rate for Payer: United Healthcare Commercial |
$232.06
|
| Rate for Payer: United Healthcare Medicare |
$148.23
|
| Rate for Payer: WINHealth Partners Commercial |
$230.85
|
| Rate for Payer: Wise Provider Network Commercial |
$230.85
|
|
|
HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
3018444601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$92.80
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.45
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$84.03
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.45
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$88.45
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
3018444601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.65
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.65
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$78.52
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.65
|
| Rate for Payer: United Healthcare Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare |
$82.65
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC ASSAY OF VITAMIN K - VITAMIN K
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
3018459701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.66
|
| Rate for Payer: Aetna of WY Medicare |
$110.22
|
| Rate for Payer: Altius Commercial |
$160.32
|
| Rate for Payer: Beech Street Commercial |
$163.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.99
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.99
|
| Rate for Payer: Cigna of WY Commercial |
$163.66
|
| Rate for Payer: Entrust Commercial |
$158.65
|
| Rate for Payer: First Choice Health Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.19
|
| Rate for Payer: HealthUtah PPO |
$167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.99
|
| Rate for Payer: Multiplan Medicare/VA |
$90.43
|
| Rate for Payer: One Health Plan of WY PPO |
$163.66
|
| Rate for Payer: PacificSource Commercial |
$150.30
|
| Rate for Payer: PHCS PPO |
$163.66
|
| Rate for Payer: Three Rivers PPO |
$125.25
|
| Rate for Payer: TriWest Veterans Administration |
$95.19
|
| Rate for Payer: United Healthcare Commercial |
$159.48
|
| Rate for Payer: United Healthcare Medicare |
$95.19
|
| Rate for Payer: WINHealth Partners Commercial |
$163.66
|
| Rate for Payer: Wise Provider Network Commercial |
$158.65
|
|
|
HC ASSAY OF VITAMIN K - VITAMIN K
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
3018459701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.66
|
| Rate for Payer: Aetna of WY Medicare |
$106.88
|
| Rate for Payer: Altius Commercial |
$160.32
|
| Rate for Payer: Beech Street Commercial |
$163.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.99
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.99
|
| Rate for Payer: Cigna of WY Commercial |
$163.66
|
| Rate for Payer: Entrust Commercial |
$158.65
|
| Rate for Payer: First Choice Health Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.87
|
| Rate for Payer: HealthUtah PPO |
$167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.99
|
| Rate for Payer: Multiplan Medicare/VA |
$96.78
|
| Rate for Payer: One Health Plan of WY PPO |
$163.66
|
| Rate for Payer: PacificSource Commercial |
$150.30
|
| Rate for Payer: PHCS PPO |
$163.66
|
| Rate for Payer: Three Rivers PPO |
$125.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.87
|
| Rate for Payer: United Healthcare Commercial |
$159.48
|
| Rate for Payer: United Healthcare Medicare |
$101.87
|
| Rate for Payer: WINHealth Partners Commercial |
$158.65
|
| Rate for Payer: Wise Provider Network Commercial |
$158.65
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VITAMIN D 25
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$131.84
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$199.82
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.66
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$119.38
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.66
|
| Rate for Payer: United Healthcare Commercial |
$196.73
|
| Rate for Payer: United Healthcare Medicare |
$125.66
|
| Rate for Payer: WINHealth Partners Commercial |
$195.70
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
