|
HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
3018388001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
3018388001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC NEEDLE BIOPSY LIVER - NEEDLE BIOPSY, LIVER
|
Facility
|
OP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
3204700001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,413.32 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,513.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,692.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,462.40
|
| Rate for Payer: Altius Commercial |
$2,462.40
|
| Rate for Payer: Beech Street Commercial |
$2,513.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,105.86
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,488.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,513.70
|
| Rate for Payer: Entrust Commercial |
$2,436.75
|
| Rate for Payer: First Choice Health Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,487.70
|
| Rate for Payer: HealthUtah PPO |
$2,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,488.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,413.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2,513.70
|
| Rate for Payer: PacificSource Commercial |
$2,308.50
|
| Rate for Payer: PHCS PPO |
$2,513.70
|
| Rate for Payer: Three Rivers PPO |
$1,923.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,487.70
|
| Rate for Payer: United Healthcare Commercial |
$2,231.55
|
| Rate for Payer: United Healthcare Medicare |
$1,487.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,513.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,436.75
|
|
|
HC NEEDLE BIOPSY LIVER - NEEDLE BIOPSY, LIVER
|
Facility
|
IP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
3204700001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,608.26 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,513.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,462.40
|
| Rate for Payer: Altius Commercial |
$2,462.40
|
| Rate for Payer: Beech Street Commercial |
$2,513.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,105.86
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,488.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,513.70
|
| Rate for Payer: Entrust Commercial |
$2,436.75
|
| Rate for Payer: First Choice Health Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,436.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,692.90
|
| Rate for Payer: HealthUtah PPO |
$2,565.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,488.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,608.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,513.70
|
| Rate for Payer: PacificSource Commercial |
$2,308.50
|
| Rate for Payer: PHCS PPO |
$2,513.70
|
| Rate for Payer: Three Rivers PPO |
$1,923.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,692.90
|
| Rate for Payer: United Healthcare Commercial |
$2,231.55
|
| Rate for Payer: United Healthcare Medicare |
$1,692.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,436.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,436.75
|
|
|
HC NEEDLE BIOPSY, LYMPH NODE(S)
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
4023850501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,386.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,218.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,157.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,218.00
|
| Rate for Payer: United Healthcare Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare Medicare |
$1,218.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,058.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
HC NEEDLE BIOPSY, LYMPH NODE(S)
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
4023850501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,316.70 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,386.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,316.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,386.00
|
| Rate for Payer: United Healthcare Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare Medicare |
$1,386.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,995.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
HC NEEDLE BIOPSY, LYMPH NODE(S)
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
3503850501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,316.70 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,386.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,316.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,386.00
|
| Rate for Payer: United Healthcare Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare Medicare |
$1,386.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,995.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
HC NEEDLE BIOPSY, LYMPH NODE(S)
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
3503850501
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,386.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,016.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,724.10
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,218.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,157.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,218.00
|
| Rate for Payer: United Healthcare Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare Medicare |
$1,218.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,058.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
|
HC NEEDLE BIOPSY OF PANCREAS - NEEDLE BIOPSY, PANCREAS
|
Facility
|
OP
|
$9,395.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
4024810201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$5,176.64 |
| Max. Negotiated Rate |
$9,395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,207.10
|
| Rate for Payer: Aetna of WY Medicare |
$6,200.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,019.20
|
| Rate for Payer: Altius Commercial |
$9,019.20
|
| Rate for Payer: Beech Street Commercial |
$9,207.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,713.30
|
| Rate for Payer: Cash Price |
$6,576.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,113.15
|
| Rate for Payer: Cigna of WY Commercial |
$9,207.10
|
| Rate for Payer: Entrust Commercial |
$8,925.25
|
| Rate for Payer: First Choice Health Commercial |
$8,925.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,925.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,449.10
|
| Rate for Payer: HealthUtah PPO |
$9,395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,113.15
|
| Rate for Payer: Multiplan Medicare/VA |
$5,176.64
|
| Rate for Payer: One Health Plan of WY PPO |
$9,207.10
|
| Rate for Payer: PacificSource Commercial |
$8,455.50
|
| Rate for Payer: PHCS PPO |
$9,207.10
|
| Rate for Payer: Three Rivers PPO |
$7,046.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,449.10
|
| Rate for Payer: United Healthcare Commercial |
$8,173.65
|
| Rate for Payer: United Healthcare Medicare |
$5,449.10
|
| Rate for Payer: WINHealth Partners Commercial |
$9,207.10
|
| Rate for Payer: Wise Provider Network Commercial |
$8,925.25
|
|
|
HC NEEDLE BIOPSY OF PANCREAS - NEEDLE BIOPSY, PANCREAS
|
Facility
|
IP
|
$9,395.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
4024810201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$5,890.66 |
| Max. Negotiated Rate |
$9,395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,207.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,019.20
|
| Rate for Payer: Altius Commercial |
$9,019.20
|
| Rate for Payer: Beech Street Commercial |
$9,207.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,713.30
|
| Rate for Payer: Cash Price |
$6,576.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,113.15
|
| Rate for Payer: Cigna of WY Commercial |
$9,207.10
|
| Rate for Payer: Entrust Commercial |
$8,925.25
|
| Rate for Payer: First Choice Health Commercial |
$8,925.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,925.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,200.70
|
| Rate for Payer: HealthUtah PPO |
$9,395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,113.15
|
| Rate for Payer: Multiplan Medicare/VA |
$5,890.66
|
| Rate for Payer: One Health Plan of WY PPO |
$9,207.10
|
| Rate for Payer: PacificSource Commercial |
$8,455.50
|
| Rate for Payer: PHCS PPO |
$9,207.10
|
| Rate for Payer: Three Rivers PPO |
$7,046.25
|
| Rate for Payer: TriWest Veterans Administration |
$6,200.70
|
| Rate for Payer: United Healthcare Commercial |
$8,173.65
|
| Rate for Payer: United Healthcare Medicare |
$6,200.70
|
| Rate for Payer: WINHealth Partners Commercial |
$8,925.25
|
| Rate for Payer: Wise Provider Network Commercial |
$8,925.25
|
|
|
HC NEEDLE BIOPSY OF PANCREAS - NEEDLE BIOPSY, PANCREAS
|
Facility
|
OP
|
$8,220.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
3204810201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,529.22 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,055.60
|
| Rate for Payer: Aetna of WY Medicare |
$5,425.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,891.20
|
| Rate for Payer: Altius Commercial |
$7,891.20
|
| Rate for Payer: Beech Street Commercial |
$8,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,748.62
|
| Rate for Payer: Cash Price |
$5,754.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,973.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,055.60
|
| Rate for Payer: Entrust Commercial |
$7,809.00
|
| Rate for Payer: First Choice Health Commercial |
$7,809.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,809.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,767.60
|
| Rate for Payer: HealthUtah PPO |
$8,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,973.40
|
| Rate for Payer: Multiplan Medicare/VA |
$4,529.22
|
| Rate for Payer: One Health Plan of WY PPO |
$8,055.60
|
| Rate for Payer: PacificSource Commercial |
$7,398.00
|
| Rate for Payer: PHCS PPO |
$8,055.60
|
| Rate for Payer: Three Rivers PPO |
$6,165.00
|
| Rate for Payer: TriWest Veterans Administration |
$4,767.60
|
| Rate for Payer: United Healthcare Commercial |
$7,151.40
|
| Rate for Payer: United Healthcare Medicare |
$4,767.60
|
| Rate for Payer: WINHealth Partners Commercial |
$8,055.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7,809.00
|
|
|
HC NEEDLE BIOPSY OF PANCREAS - NEEDLE BIOPSY, PANCREAS
|
Facility
|
IP
|
$8,220.00
|
|
|
Service Code
|
HCPCS 48102
|
| Hospital Charge Code |
3204810201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,153.94 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,055.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,891.20
|
| Rate for Payer: Altius Commercial |
$7,891.20
|
| Rate for Payer: Beech Street Commercial |
$8,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,748.62
|
| Rate for Payer: Cash Price |
$5,754.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,973.40
|
| Rate for Payer: Cigna of WY Commercial |
$8,055.60
|
| Rate for Payer: Entrust Commercial |
$7,809.00
|
| Rate for Payer: First Choice Health Commercial |
$7,809.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,809.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,425.20
|
| Rate for Payer: HealthUtah PPO |
$8,220.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,973.40
|
| Rate for Payer: Multiplan Medicare/VA |
$5,153.94
|
| Rate for Payer: One Health Plan of WY PPO |
$8,055.60
|
| Rate for Payer: PacificSource Commercial |
$7,398.00
|
| Rate for Payer: PHCS PPO |
$8,055.60
|
| Rate for Payer: Three Rivers PPO |
$6,165.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,425.20
|
| Rate for Payer: United Healthcare Commercial |
$7,151.40
|
| Rate for Payer: United Healthcare Medicare |
$5,425.20
|
| Rate for Payer: WINHealth Partners Commercial |
$7,809.00
|
| Rate for Payer: Wise Provider Network Commercial |
$7,809.00
|
|
|
HC NEEDLE BIOPSY PLEURA
|
Facility
|
OP
|
$9,400.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
3203240001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,179.40 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,212.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,204.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,024.00
|
| Rate for Payer: Altius Commercial |
$9,024.00
|
| Rate for Payer: Beech Street Commercial |
$9,212.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,717.40
|
| Rate for Payer: Cash Price |
$6,580.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,118.00
|
| Rate for Payer: Cigna of WY Commercial |
$9,212.00
|
| Rate for Payer: Entrust Commercial |
$8,930.00
|
| Rate for Payer: First Choice Health Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,452.00
|
| Rate for Payer: HealthUtah PPO |
$9,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,118.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,179.40
|
| Rate for Payer: One Health Plan of WY PPO |
$9,212.00
|
| Rate for Payer: PacificSource Commercial |
$8,460.00
|
| Rate for Payer: PHCS PPO |
$9,212.00
|
| Rate for Payer: Three Rivers PPO |
$7,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,452.00
|
| Rate for Payer: United Healthcare Commercial |
$8,178.00
|
| Rate for Payer: United Healthcare Medicare |
$5,452.00
|
| Rate for Payer: WINHealth Partners Commercial |
$9,212.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,930.00
|
|
|
HC NEEDLE BIOPSY PLEURA
|
Facility
|
IP
|
$9,400.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
3203240001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,893.80 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,212.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,024.00
|
| Rate for Payer: Altius Commercial |
$9,024.00
|
| Rate for Payer: Beech Street Commercial |
$9,212.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,717.40
|
| Rate for Payer: Cash Price |
$6,580.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,118.00
|
| Rate for Payer: Cigna of WY Commercial |
$9,212.00
|
| Rate for Payer: Entrust Commercial |
$8,930.00
|
| Rate for Payer: First Choice Health Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,204.00
|
| Rate for Payer: HealthUtah PPO |
$9,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,118.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,893.80
|
| Rate for Payer: One Health Plan of WY PPO |
$9,212.00
|
| Rate for Payer: PacificSource Commercial |
$8,460.00
|
| Rate for Payer: PHCS PPO |
$9,212.00
|
| Rate for Payer: Three Rivers PPO |
$7,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$6,204.00
|
| Rate for Payer: United Healthcare Commercial |
$8,178.00
|
| Rate for Payer: United Healthcare Medicare |
$6,204.00
|
| Rate for Payer: WINHealth Partners Commercial |
$8,930.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,930.00
|
|
|
HC NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
9229588501
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
9229588501
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
9229588601
|
|
Hospital Revenue Code
|
922
|
| 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 NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
9229588601
|
|
Hospital Revenue Code
|
922
|
| 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 NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ INTER JOINT BI
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ INTER JOINT BI
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT BI
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT BI
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT LT
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT LT
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED ASPIR OR INJ LARGE JOINT RT
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
3207700212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
