|
HC DUPLEX EXTREM VENOUS,BILAT - LOWER EXTREMITY DVT
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$990.66 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,516.80
|
| Rate for Payer: Altius Commercial |
$1,516.80
|
| Rate for Payer: Beech Street Commercial |
$1,548.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,297.18
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
| Rate for Payer: Entrust Commercial |
$1,501.00
|
| Rate for Payer: First Choice Health Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,042.80
|
| Rate for Payer: HealthUtah PPO |
$1,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
| Rate for Payer: Multiplan Medicare/VA |
$990.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
| Rate for Payer: PacificSource Commercial |
$1,422.00
|
| Rate for Payer: PHCS PPO |
$1,548.40
|
| Rate for Payer: Three Rivers PPO |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,042.80
|
| Rate for Payer: United Healthcare Commercial |
$1,374.60
|
| Rate for Payer: United Healthcare Medicare |
$1,042.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,501.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
|
HC DUPLEX EXTREM VENOUS,BILAT - LOWER EXTREMITY DVT
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$870.58 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,042.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,516.80
|
| Rate for Payer: Altius Commercial |
$1,516.80
|
| Rate for Payer: Beech Street Commercial |
$1,548.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,297.18
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
| Rate for Payer: Entrust Commercial |
$1,501.00
|
| Rate for Payer: First Choice Health Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$916.40
|
| Rate for Payer: HealthUtah PPO |
$1,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
| Rate for Payer: Multiplan Medicare/VA |
$870.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
| Rate for Payer: PacificSource Commercial |
$1,422.00
|
| Rate for Payer: PHCS PPO |
$1,548.40
|
| Rate for Payer: Three Rivers PPO |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration |
$916.40
|
| Rate for Payer: United Healthcare Commercial |
$1,374.60
|
| Rate for Payer: United Healthcare Medicare |
$916.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,548.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
|
HC DUPLEX EXTREM VENOUS,BILAT - VENOUS REFLUX DUPLEX
|
Facility
|
OP
|
$2,082.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,147.18 |
| Max. Negotiated Rate |
$2,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,040.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,374.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,998.72
|
| Rate for Payer: Altius Commercial |
$1,998.72
|
| Rate for Payer: Beech Street Commercial |
$2,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,709.32
|
| Rate for Payer: Cash Price |
$1,457.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,019.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,040.36
|
| Rate for Payer: Entrust Commercial |
$1,977.90
|
| Rate for Payer: First Choice Health Commercial |
$1,977.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,977.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,207.56
|
| Rate for Payer: HealthUtah PPO |
$2,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,019.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1,147.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,040.36
|
| Rate for Payer: PacificSource Commercial |
$1,873.80
|
| Rate for Payer: PHCS PPO |
$2,040.36
|
| Rate for Payer: Three Rivers PPO |
$1,561.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,207.56
|
| Rate for Payer: United Healthcare Commercial |
$1,811.34
|
| Rate for Payer: United Healthcare Medicare |
$1,207.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,040.36
|
| Rate for Payer: Wise Provider Network Commercial |
$1,977.90
|
|
|
HC DUPLEX EXTREM VENOUS,BILAT - VENOUS REFLUX DUPLEX
|
Facility
|
IP
|
$2,082.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,305.41 |
| Max. Negotiated Rate |
$2,082.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,040.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,998.72
|
| Rate for Payer: Altius Commercial |
$1,998.72
|
| Rate for Payer: Beech Street Commercial |
$2,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,709.32
|
| Rate for Payer: Cash Price |
$1,457.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,019.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,040.36
|
| Rate for Payer: Entrust Commercial |
$1,977.90
|
| Rate for Payer: First Choice Health Commercial |
$1,977.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,977.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,374.12
|
| Rate for Payer: HealthUtah PPO |
$2,082.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,019.54
|
| Rate for Payer: Multiplan Medicare/VA |
$1,305.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,040.36
|
| Rate for Payer: PacificSource Commercial |
$1,873.80
|
| Rate for Payer: PHCS PPO |
$2,040.36
|
| Rate for Payer: Three Rivers PPO |
$1,561.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,374.12
|
| Rate for Payer: United Healthcare Commercial |
$1,811.34
|
| Rate for Payer: United Healthcare Medicare |
$1,374.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,977.90
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.98 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.40
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$539.98
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$568.40
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$568.40
|
| Rate for Payer: WINHealth Partners Commercial |
$960.40
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$646.80
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.46
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$646.80
|
| Rate for Payer: WINHealth Partners Commercial |
$931.00
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397108
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.98 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.40
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$539.98
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$568.40
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$568.40
|
| Rate for Payer: WINHealth Partners Commercial |
$960.40
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397108
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$646.80
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.46
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$646.80
|
| Rate for Payer: WINHealth Partners Commercial |
$931.00
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD - UPPER EXTREM SUPERFICIAL VEIN MAP
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397107
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$646.80
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$614.46
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$646.80
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$646.80
|
| Rate for Payer: WINHealth Partners Commercial |
$931.00
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX EXTREM VENOUS,UNI OR LTD - UPPER EXTREM SUPERFICIAL VEIN MAP
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
9219397107
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.98 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$940.80
|
| Rate for Payer: Altius Commercial |
$940.80
|
| Rate for Payer: Beech Street Commercial |
$960.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$804.58
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: Entrust Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$568.40
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$539.98
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$960.40
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$568.40
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$568.40
|
| Rate for Payer: WINHealth Partners Commercial |
$960.40
|
| Rate for Payer: Wise Provider Network Commercial |
$931.00
|
|
|
HC DUPLEX LARGE VESSEL(S),LIMITED
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
9219397901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$256.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Aetna of WY Medicare |
$306.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.70
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$256.22
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$269.70
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$269.70
|
| Rate for Payer: WINHealth Partners Commercial |
$455.70
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC DUPLEX LARGE VESSEL(S),LIMITED
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
9219397901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.90
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$291.56
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.90
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$306.90
|
| Rate for Payer: WINHealth Partners Commercial |
$441.75
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC DUPLEX LO EXTREM ART BILAT - LOWER EXTREMITY ARTERIAL DUPLEX
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
9219392502
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$622.63 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Aetna of WY Medicare |
$745.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.80
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.73
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.40
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$622.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$655.40
|
| Rate for Payer: United Healthcare Commercial |
$983.10
|
| Rate for Payer: United Healthcare Medicare |
$655.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC DUPLEX LO EXTREM ART BILAT - LOWER EXTREMITY ARTERIAL DUPLEX
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
9219392502
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$708.51 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.80
|
| Rate for Payer: Altius Commercial |
$1,084.80
|
| Rate for Payer: Beech Street Commercial |
$1,107.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.73
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,096.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.40
|
| Rate for Payer: Entrust Commercial |
$1,073.50
|
| Rate for Payer: First Choice Health Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.80
|
| Rate for Payer: HealthUtah PPO |
$1,130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,096.10
|
| Rate for Payer: Multiplan Medicare/VA |
$708.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.40
|
| Rate for Payer: PacificSource Commercial |
$1,017.00
|
| Rate for Payer: PHCS PPO |
$1,107.40
|
| Rate for Payer: Three Rivers PPO |
$847.50
|
| Rate for Payer: TriWest Veterans Administration |
$745.80
|
| Rate for Payer: United Healthcare Commercial |
$983.10
|
| Rate for Payer: United Healthcare Medicare |
$745.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,073.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.50
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
OP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
9219388003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,132.30 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,013.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,356.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,972.80
|
| Rate for Payer: Altius Commercial |
$1,972.80
|
| Rate for Payer: Beech Street Commercial |
$2,013.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,687.16
|
| Rate for Payer: Cash Price |
$1,438.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,993.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,013.90
|
| Rate for Payer: Entrust Commercial |
$1,952.25
|
| Rate for Payer: First Choice Health Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,191.90
|
| Rate for Payer: HealthUtah PPO |
$2,055.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,993.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,132.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,013.90
|
| Rate for Payer: PacificSource Commercial |
$1,849.50
|
| Rate for Payer: PHCS PPO |
$2,013.90
|
| Rate for Payer: Three Rivers PPO |
$1,541.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,191.90
|
| Rate for Payer: United Healthcare Commercial |
$1,787.85
|
| Rate for Payer: United Healthcare Medicare |
$1,191.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,013.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,952.25
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
IP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
4839388001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,288.48 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,013.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,972.80
|
| Rate for Payer: Altius Commercial |
$1,972.80
|
| Rate for Payer: Beech Street Commercial |
$2,013.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,687.16
|
| Rate for Payer: Cash Price |
$1,438.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,993.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,013.90
|
| Rate for Payer: Entrust Commercial |
$1,952.25
|
| Rate for Payer: First Choice Health Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,356.30
|
| Rate for Payer: HealthUtah PPO |
$2,055.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,993.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,288.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,013.90
|
| Rate for Payer: PacificSource Commercial |
$1,849.50
|
| Rate for Payer: PHCS PPO |
$2,013.90
|
| Rate for Payer: Three Rivers PPO |
$1,541.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,356.30
|
| Rate for Payer: United Healthcare Commercial |
$1,787.85
|
| Rate for Payer: United Healthcare Medicare |
$1,356.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,952.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,952.25
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
OP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
4839388001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,132.30 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,013.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,356.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,972.80
|
| Rate for Payer: Altius Commercial |
$1,972.80
|
| Rate for Payer: Beech Street Commercial |
$2,013.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,687.16
|
| Rate for Payer: Cash Price |
$1,438.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,993.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,013.90
|
| Rate for Payer: Entrust Commercial |
$1,952.25
|
| Rate for Payer: First Choice Health Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,191.90
|
| Rate for Payer: HealthUtah PPO |
$2,055.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,993.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,132.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,013.90
|
| Rate for Payer: PacificSource Commercial |
$1,849.50
|
| Rate for Payer: PHCS PPO |
$2,013.90
|
| Rate for Payer: Three Rivers PPO |
$1,541.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,191.90
|
| Rate for Payer: United Healthcare Commercial |
$1,787.85
|
| Rate for Payer: United Healthcare Medicare |
$1,191.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,013.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,952.25
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
IP
|
$2,055.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
9219388003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,288.48 |
| Max. Negotiated Rate |
$2,055.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,013.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,972.80
|
| Rate for Payer: Altius Commercial |
$1,972.80
|
| Rate for Payer: Beech Street Commercial |
$2,013.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,687.16
|
| Rate for Payer: Cash Price |
$1,438.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,993.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,013.90
|
| Rate for Payer: Entrust Commercial |
$1,952.25
|
| Rate for Payer: First Choice Health Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,952.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,356.30
|
| Rate for Payer: HealthUtah PPO |
$2,055.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,993.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,288.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,013.90
|
| Rate for Payer: PacificSource Commercial |
$1,849.50
|
| Rate for Payer: PHCS PPO |
$2,013.90
|
| Rate for Payer: Three Rivers PPO |
$1,541.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,356.30
|
| Rate for Payer: United Healthcare Commercial |
$1,787.85
|
| Rate for Payer: United Healthcare Medicare |
$1,356.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,952.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,952.25
|
|
|
HC DUPLEX UPP EXT ART LT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DUPLEX UPP EXT ART LT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DUPLEX UPP EXT ART RT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DUPLEX UPP EXT ART RT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
3207708002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Aetna of WY Medicare |
$402.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$585.60
|
| Rate for Payer: Altius Commercial |
$585.60
|
| Rate for Payer: Beech Street Commercial |
$597.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.81
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: Entrust Commercial |
$579.50
|
| Rate for Payer: First Choice Health Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.80
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$336.11
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$597.80
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$353.80
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$353.80
|
| Rate for Payer: WINHealth Partners Commercial |
$597.80
|
| Rate for Payer: Wise Provider Network Commercial |
$579.50
|
|
|
HC DXA BONE DENSITY AXIAL - DEXA BONE DENSITY
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
3207708002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$585.60
|
| Rate for Payer: Altius Commercial |
$585.60
|
| Rate for Payer: Beech Street Commercial |
$597.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.81
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: Entrust Commercial |
$579.50
|
| Rate for Payer: First Choice Health Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$402.60
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$382.47
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$597.80
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$402.60
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$402.60
|
| Rate for Payer: WINHealth Partners Commercial |
$579.50
|
| Rate for Payer: Wise Provider Network Commercial |
$579.50
|
|
|
HC DXA BONE DENSITY/PERIPHERAL - DEXA BONE DENSITY EXTREMITY
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 77081
|
| Hospital Charge Code |
3207708101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$260.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.10
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$217.64
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.10
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$387.10
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
