|
HC DETECT AGENT,IMMUN,DIR OBS,STREP B - STREP B ANTIGEN
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 87802
|
| Hospital Charge Code |
3068780201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC DETECT AGENT, MULT ORGS, DNA, AMP - GC CHLAMYDIA PROBE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
3068780102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC DETECT AGENT, MULT ORGS, DNA, AMP - GC CHLAMYDIA PROBE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
3068780102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC DETECT AGENT, MULT ORGS, DNA, AMP - LYME DISEASE DNA BY PCR
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
3068780104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC DETECT AGENT, MULT ORGS, DNA, AMP - LYME DISEASE DNA BY PCR
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
3068780104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC DETECT AGENT NOS, DNA, DIR - ADENOVIRUS BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779732
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - ADENOVIRUS BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779732
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - ADENOVIRUS PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779714
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - ADENOVIRUS PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779714
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - ASTROVIRUS PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779715
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - ASTROVIRUS PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779715
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CAMPYLOBACTER PCR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779703
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CAMPYLOBACTER PCR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779703
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| 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 |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| 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 |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
|
HC DETECT AGENT NOS, DNA, DIR - CORONAVIRUS 229E BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779729
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS 229E BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779729
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS HKU1 BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779727
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS HKU1 BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779727
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS NL63 BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779728
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS NL63 BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779728
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS OC43 BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779730
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CORONAVIRUS OC43 BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779730
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CYCLORSPORA CAYETANENSIS PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779711
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - CYCLORSPORA CAYETANENSIS PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779711
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - E COLI 0157 PCR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779709
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT NOS, DNA, DIR - E COLI 0157 PCR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779709
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| 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 |
$198.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: Multiplan Medicare/VA |
$188.10
|
| 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 |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicare |
$198.00
|
| Rate for Payer: WINHealth Partners Commercial |
$285.00
|
| Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|
