|
HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
3068733801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC IAAD IA HPYLORI STOOL - H PYLORI ANTIGEN STOOL
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
3068733801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - CAMPYLOBACTER AG
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - CAMPYLOBACTER AG
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - LEGIONELLA ANTIGEN, UR
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - LEGIONELLA ANTIGEN, UR
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - STREP PNEUMONIA AG
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - STREP PNEUMONIA AG
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
3068744904
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
3068730501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
3068730501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC IAAD IA RESPIRATORY SYNCTIAL VIRUS - RSV RAPID ANTIGEN SCREEN
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
3068742001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC IAAD IA RESPIRATORY SYNCTIAL VIRUS - RSV RAPID ANTIGEN SCREEN
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
3068742001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
3068742501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| 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 |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| 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 |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
3068742501
|
|
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 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87426
|
| Hospital Charge Code |
3068742601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87426
|
| Hospital Charge Code |
3068742601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN, EIA
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
3068742701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN, EIA
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
3068742701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC IADNA-DNA/RNA PROBE TQ 12-25 - GASTROINTESTINAL PANEL
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
3068750701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$306.91 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$545.86
|
| Rate for Payer: Aetna of WY Medicare |
$367.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$534.72
|
| Rate for Payer: Altius Commercial |
$534.72
|
| Rate for Payer: Beech Street Commercial |
$545.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$457.30
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$540.29
|
| Rate for Payer: Cigna of WY Commercial |
$545.86
|
| Rate for Payer: Entrust Commercial |
$529.15
|
| Rate for Payer: First Choice Health Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.06
|
| Rate for Payer: HealthUtah PPO |
$557.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$540.29
|
| Rate for Payer: Multiplan Medicare/VA |
$306.91
|
| Rate for Payer: One Health Plan of WY PPO |
$545.86
|
| Rate for Payer: PacificSource Commercial |
$501.30
|
| Rate for Payer: PHCS PPO |
$545.86
|
| Rate for Payer: Three Rivers PPO |
$417.75
|
| Rate for Payer: TriWest Veterans Administration |
$323.06
|
| Rate for Payer: United Healthcare Commercial |
$484.59
|
| Rate for Payer: United Healthcare Medicare |
$323.06
|
| Rate for Payer: WINHealth Partners Commercial |
$545.86
|
| Rate for Payer: Wise Provider Network Commercial |
$529.15
|
|
|
HC IADNA-DNA/RNA PROBE TQ 12-25 - GASTROINTESTINAL PANEL
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
3068750701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$349.24 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$545.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$534.72
|
| Rate for Payer: Altius Commercial |
$534.72
|
| Rate for Payer: Beech Street Commercial |
$545.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$457.30
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$540.29
|
| Rate for Payer: Cigna of WY Commercial |
$545.86
|
| Rate for Payer: Entrust Commercial |
$529.15
|
| Rate for Payer: First Choice Health Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$367.62
|
| Rate for Payer: HealthUtah PPO |
$557.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$540.29
|
| Rate for Payer: Multiplan Medicare/VA |
$349.24
|
| Rate for Payer: One Health Plan of WY PPO |
$545.86
|
| Rate for Payer: PacificSource Commercial |
$501.30
|
| Rate for Payer: PHCS PPO |
$545.86
|
| Rate for Payer: Three Rivers PPO |
$417.75
|
| Rate for Payer: TriWest Veterans Administration |
$367.62
|
| Rate for Payer: United Healthcare Commercial |
$484.59
|
| Rate for Payer: United Healthcare Medicare |
$367.62
|
| Rate for Payer: WINHealth Partners Commercial |
$529.15
|
| Rate for Payer: Wise Provider Network Commercial |
$529.15
|
|
|
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3068752201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.30
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$285.28
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.30
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3068752201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
3068763301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
3068763301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 87631
|
| Hospital Charge Code |
3098763101
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$254.56 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$389.76
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$333.33
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.96
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$254.56
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$267.96
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$267.96
|
| Rate for Payer: WINHealth Partners Commercial |
$385.70
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
