|
HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US INTRAOPERATIVE
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4027699802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$484.33 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$861.42
|
| Rate for Payer: Aetna of WY Medicare |
$580.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$843.84
|
| Rate for Payer: Altius Commercial |
$843.84
|
| Rate for Payer: Beech Street Commercial |
$861.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$721.66
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$852.63
|
| Rate for Payer: Cigna of WY Commercial |
$861.42
|
| Rate for Payer: Entrust Commercial |
$835.05
|
| Rate for Payer: First Choice Health Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$509.82
|
| Rate for Payer: HealthUtah PPO |
$879.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$852.63
|
| Rate for Payer: Multiplan Medicare/VA |
$484.33
|
| Rate for Payer: One Health Plan of WY PPO |
$861.42
|
| Rate for Payer: PacificSource Commercial |
$791.10
|
| Rate for Payer: PHCS PPO |
$861.42
|
| Rate for Payer: Three Rivers PPO |
$659.25
|
| Rate for Payer: TriWest Veterans Administration |
$509.82
|
| Rate for Payer: United Healthcare Commercial |
$764.73
|
| Rate for Payer: United Healthcare Medicare |
$509.82
|
| Rate for Payer: WINHealth Partners Commercial |
$861.42
|
| Rate for Payer: Wise Provider Network Commercial |
$835.05
|
|
|
HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US PROSTATE WITH BIOPSY
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4027699801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$567.44 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$886.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$868.80
|
| Rate for Payer: Altius Commercial |
$868.80
|
| Rate for Payer: Beech Street Commercial |
$886.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.00
|
| Rate for Payer: Cash Price |
$633.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$877.85
|
| Rate for Payer: Cigna of WY Commercial |
$886.90
|
| Rate for Payer: Entrust Commercial |
$859.75
|
| Rate for Payer: First Choice Health Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$597.30
|
| Rate for Payer: HealthUtah PPO |
$905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$877.85
|
| Rate for Payer: Multiplan Medicare/VA |
$567.44
|
| Rate for Payer: One Health Plan of WY PPO |
$886.90
|
| Rate for Payer: PacificSource Commercial |
$814.50
|
| Rate for Payer: PHCS PPO |
$886.90
|
| Rate for Payer: Three Rivers PPO |
$678.75
|
| Rate for Payer: TriWest Veterans Administration |
$597.30
|
| Rate for Payer: United Healthcare Commercial |
$787.35
|
| Rate for Payer: United Healthcare Medicare |
$597.30
|
| Rate for Payer: WINHealth Partners Commercial |
$859.75
|
| Rate for Payer: Wise Provider Network Commercial |
$859.75
|
|
|
HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US PROSTATE WITH BIOPSY
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4027699801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$498.66 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$886.90
|
| Rate for Payer: Aetna of WY Medicare |
$597.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$868.80
|
| Rate for Payer: Altius Commercial |
$868.80
|
| Rate for Payer: Beech Street Commercial |
$886.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$743.00
|
| Rate for Payer: Cash Price |
$633.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$877.85
|
| Rate for Payer: Cigna of WY Commercial |
$886.90
|
| Rate for Payer: Entrust Commercial |
$859.75
|
| Rate for Payer: First Choice Health Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$859.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$524.90
|
| Rate for Payer: HealthUtah PPO |
$905.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$877.85
|
| Rate for Payer: Multiplan Medicare/VA |
$498.66
|
| Rate for Payer: One Health Plan of WY PPO |
$886.90
|
| Rate for Payer: PacificSource Commercial |
$814.50
|
| Rate for Payer: PHCS PPO |
$886.90
|
| Rate for Payer: Three Rivers PPO |
$678.75
|
| Rate for Payer: TriWest Veterans Administration |
$524.90
|
| Rate for Payer: United Healthcare Commercial |
$787.35
|
| Rate for Payer: United Healthcare Medicare |
$524.90
|
| Rate for Payer: WINHealth Partners Commercial |
$886.90
|
| Rate for Payer: Wise Provider Network Commercial |
$859.75
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$760.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST BILATERAL COMPLETE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Aetna of WY Medicare |
$528.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$464.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$440.80
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$464.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
| Rate for Payer: WINHealth Partners Commercial |
$784.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST LEFT COMPLETE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664102
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$760.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST LEFT COMPLETE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664102
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Aetna of WY Medicare |
$528.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$464.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$440.80
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$464.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
| Rate for Payer: WINHealth Partners Commercial |
$784.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST RIGHT COMPLETE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Aetna of WY Medicare |
$528.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$464.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$440.80
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$464.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$464.00
|
| Rate for Payer: WINHealth Partners Commercial |
$784.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST COMPLETE - US BREAST RIGHT COMPLETE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
4027664103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$760.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST BILATERAL LIMITED
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$661.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,176.00
|
| Rate for Payer: Aetna of WY Medicare |
$792.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,152.00
|
| Rate for Payer: Altius Commercial |
$1,152.00
|
| Rate for Payer: Beech Street Commercial |
$1,176.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$985.20
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,164.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,176.00
|
| Rate for Payer: Entrust Commercial |
$1,140.00
|
| Rate for Payer: First Choice Health Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.00
|
| Rate for Payer: HealthUtah PPO |
$1,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,164.00
|
| Rate for Payer: Multiplan Medicare/VA |
$661.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,176.00
|
| Rate for Payer: PacificSource Commercial |
$1,080.00
|
| Rate for Payer: PHCS PPO |
$1,176.00
|
| Rate for Payer: Three Rivers PPO |
$900.00
|
| Rate for Payer: TriWest Veterans Administration |
$696.00
|
| Rate for Payer: United Healthcare Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare Medicare |
$696.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,176.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,140.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST BILATERAL LIMITED
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,176.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,152.00
|
| Rate for Payer: Altius Commercial |
$1,152.00
|
| Rate for Payer: Beech Street Commercial |
$1,176.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$985.20
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,164.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,176.00
|
| Rate for Payer: Entrust Commercial |
$1,140.00
|
| Rate for Payer: First Choice Health Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,140.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$792.00
|
| Rate for Payer: HealthUtah PPO |
$1,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,164.00
|
| Rate for Payer: Multiplan Medicare/VA |
$752.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,176.00
|
| Rate for Payer: PacificSource Commercial |
$1,080.00
|
| Rate for Payer: PHCS PPO |
$1,176.00
|
| Rate for Payer: Three Rivers PPO |
$900.00
|
| Rate for Payer: TriWest Veterans Administration |
$792.00
|
| Rate for Payer: United Healthcare Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare Medicare |
$792.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,140.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,140.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST LEFT LIMITED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST LEFT LIMITED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST RIGHT LIMITED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.58 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$382.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.40
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$319.58
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$336.40
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$336.40
|
| Rate for Payer: WINHealth Partners Commercial |
$568.40
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC ULTRASOUND BREAST LIMITED - US BREAST RIGHT LIMITED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4027664202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$556.80
|
| Rate for Payer: Altius Commercial |
$556.80
|
| Rate for Payer: Beech Street Commercial |
$568.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$476.18
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: Entrust Commercial |
$551.00
|
| Rate for Payer: First Choice Health Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$568.40
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$504.60
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$551.00
|
| Rate for Payer: Wise Provider Network Commercial |
$551.00
|
|
|
HC ULTRASOUND SURG DEV
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
3600000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC ULTRASOUND SURG DEV
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
3600000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC UMBILICAL CORD DRUG SCREEN
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030725
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$787.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Aetna of WY Medicare |
$943.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$787.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$829.40
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$829.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC UMBILICAL CORD DRUG SCREEN
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030725
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$896.61 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
| Rate for Payer: Altius Commercial |
$1,372.80
|
| Rate for Payer: Beech Street Commercial |
$1,401.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
| Rate for Payer: Cash Price |
$1,001.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
| Rate for Payer: Entrust Commercial |
$1,358.50
|
| Rate for Payer: First Choice Health Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.80
|
| Rate for Payer: HealthUtah PPO |
$1,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
| Rate for Payer: Multiplan Medicare/VA |
$896.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
| Rate for Payer: PacificSource Commercial |
$1,287.00
|
| Rate for Payer: PHCS PPO |
$1,401.40
|
| Rate for Payer: Three Rivers PPO |
$1,072.50
|
| Rate for Payer: TriWest Veterans Administration |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Medicare |
$943.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,358.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
|
HC UNLISTED AMBULANCE SERICE; COURTESY TRANSPORT
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS A0999
|
| Hospital Charge Code |
542A099901
|
|
Hospital Revenue Code
|
542
|
| Min. Negotiated Rate |
$347.98 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.80
|
| Rate for Payer: Altius Commercial |
$532.80
|
| Rate for Payer: Beech Street Commercial |
$543.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.66
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.35
|
| Rate for Payer: Cigna of WY Commercial |
$543.90
|
| Rate for Payer: Entrust Commercial |
$527.25
|
| Rate for Payer: First Choice Health Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$366.30
|
| Rate for Payer: HealthUtah PPO |
$555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.35
|
| Rate for Payer: Multiplan Medicare/VA |
$347.98
|
| Rate for Payer: One Health Plan of WY PPO |
$543.90
|
| Rate for Payer: PacificSource Commercial |
$499.50
|
| Rate for Payer: PHCS PPO |
$543.90
|
| Rate for Payer: Three Rivers PPO |
$416.25
|
| Rate for Payer: TriWest Veterans Administration |
$366.30
|
| Rate for Payer: United Healthcare Commercial |
$482.85
|
| Rate for Payer: United Healthcare Medicare |
$366.30
|
| Rate for Payer: WINHealth Partners Commercial |
$527.25
|
| Rate for Payer: Wise Provider Network Commercial |
$527.25
|
|
|
HC UNLISTED AMBULANCE SERICE; COURTESY TRANSPORT
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS A0999
|
| Hospital Charge Code |
542A099901
|
|
Hospital Revenue Code
|
542
|
| Min. Negotiated Rate |
$305.80 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$543.90
|
| Rate for Payer: Aetna of WY Medicare |
$366.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$532.80
|
| Rate for Payer: Altius Commercial |
$532.80
|
| Rate for Payer: Beech Street Commercial |
$543.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$455.66
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$538.35
|
| Rate for Payer: Cigna of WY Commercial |
$543.90
|
| Rate for Payer: Entrust Commercial |
$527.25
|
| Rate for Payer: First Choice Health Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$527.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.90
|
| Rate for Payer: HealthUtah PPO |
$555.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$538.35
|
| Rate for Payer: Multiplan Medicare/VA |
$305.80
|
| Rate for Payer: One Health Plan of WY PPO |
$543.90
|
| Rate for Payer: PacificSource Commercial |
$499.50
|
| Rate for Payer: PHCS PPO |
$543.90
|
| Rate for Payer: Three Rivers PPO |
$416.25
|
| Rate for Payer: TriWest Veterans Administration |
$321.90
|
| Rate for Payer: United Healthcare Commercial |
$482.85
|
| Rate for Payer: United Healthcare Medicare |
$321.90
|
| Rate for Payer: WINHealth Partners Commercial |
$543.90
|
| Rate for Payer: Wise Provider Network Commercial |
$527.25
|
|
|
HC UNLISTED AMBULANCE SERICE; COURTESY TRANSPORT MILES
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS A0999
|
| Hospital Charge Code |
542A099902
|
|
Hospital Revenue Code
|
542
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Aetna of WY Medicare |
$9.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.70
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC UNLISTED AMBULANCE SERICE; COURTESY TRANSPORT MILES
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS A0999
|
| Hospital Charge Code |
542A099902
|
|
Hospital Revenue Code
|
542
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.40
|
| Rate for Payer: Altius Commercial |
$14.40
|
| Rate for Payer: Beech Street Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.32
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.55
|
| Rate for Payer: Cigna of WY Commercial |
$14.70
|
| Rate for Payer: Entrust Commercial |
$14.25
|
| Rate for Payer: First Choice Health Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.90
|
| Rate for Payer: HealthUtah PPO |
$15.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.55
|
| Rate for Payer: Multiplan Medicare/VA |
$9.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.70
|
| Rate for Payer: PacificSource Commercial |
$13.50
|
| Rate for Payer: PHCS PPO |
$14.70
|
| Rate for Payer: Three Rivers PPO |
$11.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$9.90
|
| Rate for Payer: WINHealth Partners Commercial |
$14.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.25
|
|
|
HC UNLISTED CASTING/STRAPPING
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
7612979901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC UNLISTED CASTING/STRAPPING
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29799
|
| Hospital Charge Code |
7612979901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
