|
HC DETECT AGENT NOS, DNA, DIR - RESPIRATORY PANEL
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779733
|
|
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 - RHINO/ENTEROVIRUS BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779731
|
|
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 - RHINO/ENTEROVIRUS BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779731
|
|
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 - ROTOVIRUS PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779716
|
|
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 - ROTOVIRUS PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779716
|
|
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 - RSV BY PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779722
|
|
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 - RSV BY PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779722
|
|
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 - SALMONELLA PCR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779705
|
|
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 - SALMONELLA PCR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779705
|
|
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 - SAPOVIRUS PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779717
|
|
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 - SAPOVIRUS PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779717
|
|
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 - SHIGELLA/ENTEROINVASIVE ECOLI
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779710
|
|
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 - SHIGELLA/ENTEROINVASIVE ECOLI
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779710
|
|
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 - VIBRIO PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779706
|
|
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 - VIBRIO PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779706
|
|
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 - YERSENIA ENTEROCOLITICA PCR
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779707
|
|
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 - YERSENIA ENTEROCOLITICA PCR
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 87797
|
| Hospital Charge Code |
3068779707
|
|
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, QUANT - BK VIRUS, DNA, PLASMA PCR
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779909
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - BK VIRUS, DNA, PLASMA PCR
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779909
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - BK VIRUS, DNA, SERUM, QUANTITATIVE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - BK VIRUS, DNA, SERUM, QUANTITATIVE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - HEPATITIS E QUANTITATIVE PCR
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - HEPATITIS E QUANTITATIVE PCR
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - PARVOVIRUS B19 PCR
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC DETECT AGENT NOS, DNA, QUANT - PARVOVIRUS B19 PCR
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
3068779907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
