|
HC URINE ALBUMIN SEMIQUANTITATIVE - 24 HOURS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
3018204401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC URINE ALBUMIN SEMIQUANTITATIVE - RANDOM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
3018204402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC URINE ALBUMIN SEMIQUANTITATIVE - RANDOM
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
3018204402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC URINE BACTERIA CULTURE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
3068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC URINE BACTERIA CULTURE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
3068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC URINE CULTURE QUANTITATIVE COLONY COUNT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
3068708601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC URINE CULTURE QUANTITATIVE COLONY COUNT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
3068708601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.10
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$53.30
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$56.10
|
| Rate for Payer: WINHealth Partners Commercial |
$80.75
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.30
|
| Rate for Payer: Aetna of WY Medicare |
$56.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.60
|
| Rate for Payer: Altius Commercial |
$81.60
|
| Rate for Payer: Beech Street Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.45
|
| Rate for Payer: Cigna of WY Commercial |
$83.30
|
| Rate for Payer: Entrust Commercial |
$80.75
|
| Rate for Payer: First Choice Health Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.30
|
| Rate for Payer: HealthUtah PPO |
$85.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.45
|
| Rate for Payer: Multiplan Medicare/VA |
$46.84
|
| Rate for Payer: One Health Plan of WY PPO |
$83.30
|
| Rate for Payer: PacificSource Commercial |
$76.50
|
| Rate for Payer: PHCS PPO |
$83.30
|
| Rate for Payer: Three Rivers PPO |
$63.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.30
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
| Rate for Payer: WINHealth Partners Commercial |
$83.30
|
| Rate for Payer: Wise Provider Network Commercial |
$80.75
|
|
|
HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
4027670601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$427.02 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$759.50
|
| Rate for Payer: Aetna of WY Medicare |
$511.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$744.00
|
| Rate for Payer: Altius Commercial |
$744.00
|
| Rate for Payer: Beech Street Commercial |
$759.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$636.28
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$751.75
|
| Rate for Payer: Cigna of WY Commercial |
$759.50
|
| Rate for Payer: Entrust Commercial |
$736.25
|
| Rate for Payer: First Choice Health Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.50
|
| Rate for Payer: HealthUtah PPO |
$775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$751.75
|
| Rate for Payer: Multiplan Medicare/VA |
$427.02
|
| Rate for Payer: One Health Plan of WY PPO |
$759.50
|
| Rate for Payer: PacificSource Commercial |
$697.50
|
| Rate for Payer: PHCS PPO |
$759.50
|
| Rate for Payer: Three Rivers PPO |
$581.25
|
| Rate for Payer: TriWest Veterans Administration |
$449.50
|
| Rate for Payer: United Healthcare Commercial |
$674.25
|
| Rate for Payer: United Healthcare Medicare |
$449.50
|
| Rate for Payer: WINHealth Partners Commercial |
$759.50
|
| Rate for Payer: Wise Provider Network Commercial |
$736.25
|
|
|
HC US ABDL AORTA SCREEN AAA - US ABDOMEN AORTIC ANEURYSM SCREENING
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
4027670601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.92 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$759.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$744.00
|
| Rate for Payer: Altius Commercial |
$744.00
|
| Rate for Payer: Beech Street Commercial |
$759.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$636.28
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$751.75
|
| Rate for Payer: Cigna of WY Commercial |
$759.50
|
| Rate for Payer: Entrust Commercial |
$736.25
|
| Rate for Payer: First Choice Health Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$736.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.50
|
| Rate for Payer: HealthUtah PPO |
$775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$751.75
|
| Rate for Payer: Multiplan Medicare/VA |
$485.92
|
| Rate for Payer: One Health Plan of WY PPO |
$759.50
|
| Rate for Payer: PacificSource Commercial |
$697.50
|
| Rate for Payer: PHCS PPO |
$759.50
|
| Rate for Payer: Three Rivers PPO |
$581.25
|
| Rate for Payer: TriWest Veterans Administration |
$511.50
|
| Rate for Payer: United Healthcare Commercial |
$674.25
|
| Rate for Payer: United Healthcare Medicare |
$511.50
|
| Rate for Payer: WINHealth Partners Commercial |
$736.25
|
| Rate for Payer: Wise Provider Network Commercial |
$736.25
|
|
|
HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
4027670002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$833.91 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,276.80
|
| Rate for Payer: Altius Commercial |
$1,276.80
|
| Rate for Payer: Beech Street Commercial |
$1,303.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,091.93
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
| Rate for Payer: Entrust Commercial |
$1,263.50
|
| Rate for Payer: First Choice Health Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$877.80
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$833.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
| Rate for Payer: PacificSource Commercial |
$1,197.00
|
| Rate for Payer: PHCS PPO |
$1,303.40
|
| Rate for Payer: Three Rivers PPO |
$997.50
|
| Rate for Payer: TriWest Veterans Administration |
$877.80
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$877.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,263.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,263.50
|
|
|
HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE - US ABDOMEN COMPLETE
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
4027670002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$732.83 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
| Rate for Payer: Aetna of WY Medicare |
$877.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,276.80
|
| Rate for Payer: Altius Commercial |
$1,276.80
|
| Rate for Payer: Beech Street Commercial |
$1,303.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,091.93
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
| Rate for Payer: Entrust Commercial |
$1,263.50
|
| Rate for Payer: First Choice Health Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$771.40
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$732.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
| Rate for Payer: PacificSource Commercial |
$1,197.00
|
| Rate for Payer: PHCS PPO |
$1,303.40
|
| Rate for Payer: Three Rivers PPO |
$997.50
|
| Rate for Payer: TriWest Veterans Administration |
$771.40
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$771.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,303.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,263.50
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$413.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Aetna of WY Medicare |
$495.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$413.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$435.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$435.00
|
| Rate for Payer: WINHealth Partners Commercial |
$735.00
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$470.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$495.00
|
| Rate for Payer: WINHealth Partners Commercial |
$712.50
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC US, ABDOMEN LIMITED - US LOWER BACK
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$413.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Aetna of WY Medicare |
$495.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$413.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$435.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$435.00
|
| Rate for Payer: WINHealth Partners Commercial |
$735.00
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC US, ABDOMEN LIMITED - US LOWER BACK
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$470.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$495.00
|
| Rate for Payer: WINHealth Partners Commercial |
$712.50
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC US, ABDOMEN LIMITED - US PELVIS APPENDIX
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670504
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC US, ABDOMEN LIMITED - US PELVIS APPENDIX
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670504
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.70
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$366.42
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$385.70
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$385.70
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC US AXILLA
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688206
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.90 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$494.40
|
| Rate for Payer: Altius Commercial |
$494.40
|
| Rate for Payer: Beech Street Commercial |
$504.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$422.82
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: Entrust Commercial |
$489.25
|
| Rate for Payer: First Choice Health Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.90
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$322.90
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$504.70
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$339.90
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$339.90
|
| Rate for Payer: WINHealth Partners Commercial |
$489.25
|
| Rate for Payer: Wise Provider Network Commercial |
$489.25
|
|
|
HC US AXILLA
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688206
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.76 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$339.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$494.40
|
| Rate for Payer: Altius Commercial |
$494.40
|
| Rate for Payer: Beech Street Commercial |
$504.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$422.82
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: Entrust Commercial |
$489.25
|
| Rate for Payer: First Choice Health Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.70
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$283.76
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$504.70
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$298.70
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$298.70
|
| Rate for Payer: WINHealth Partners Commercial |
$504.70
|
| Rate for Payer: Wise Provider Network Commercial |
$489.25
|
|
|
HC US, CHEST,REAL TIME - US CHEST
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC US, CHEST,REAL TIME - US CHEST
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC US COMPL JOINT R-T W/IMG - US KNEE LEFT
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Aetna of WY Medicare |
$537.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.70
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$449.06
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$472.70
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$472.70
|
| Rate for Payer: WINHealth Partners Commercial |
$798.70
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
|
HC US COMPL JOINT R-T W/IMG - US KNEE LEFT
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$798.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$782.40
|
| Rate for Payer: Altius Commercial |
$782.40
|
| Rate for Payer: Beech Street Commercial |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$669.12
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$790.55
|
| Rate for Payer: Cigna of WY Commercial |
$798.70
|
| Rate for Payer: Entrust Commercial |
$774.25
|
| Rate for Payer: First Choice Health Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$774.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$537.90
|
| Rate for Payer: HealthUtah PPO |
$815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$790.55
|
| Rate for Payer: Multiplan Medicare/VA |
$511.00
|
| Rate for Payer: One Health Plan of WY PPO |
$798.70
|
| Rate for Payer: PacificSource Commercial |
$733.50
|
| Rate for Payer: PHCS PPO |
$798.70
|
| Rate for Payer: Three Rivers PPO |
$611.25
|
| Rate for Payer: TriWest Veterans Administration |
$537.90
|
| Rate for Payer: United Healthcare Commercial |
$709.05
|
| Rate for Payer: United Healthcare Medicare |
$537.90
|
| Rate for Payer: WINHealth Partners Commercial |
$774.25
|
| Rate for Payer: Wise Provider Network Commercial |
$774.25
|
|
