|
HC US COMPL JOINT R-T W/IMG - US KNEE RIGHT
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688102
|
|
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 RIGHT
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688102
|
|
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
|
|
|
HC US COMPL JOINT R-T W/IMG - US WRIST RIGHT
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688112
|
|
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 WRIST RIGHT
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
4027688112
|
|
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
|
|
|
HC US ECHOCARDIOGRAPHY WITH CONTRAST
|
Facility
|
OP
|
$2,501.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483C892901
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,378.05 |
| Max. Negotiated Rate |
$2,501.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,650.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.96
|
| Rate for Payer: Altius Commercial |
$2,400.96
|
| Rate for Payer: Beech Street Commercial |
$2,450.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,053.32
|
| Rate for Payer: Cash Price |
$1,750.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.98
|
| Rate for Payer: Entrust Commercial |
$2,375.95
|
| Rate for Payer: First Choice Health Commercial |
$2,375.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,450.58
|
| Rate for Payer: HealthUtah PPO |
$2,501.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,378.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.98
|
| Rate for Payer: PacificSource Commercial |
$2,250.90
|
| Rate for Payer: PHCS PPO |
$2,450.98
|
| Rate for Payer: Three Rivers PPO |
$1,875.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,450.58
|
| Rate for Payer: United Healthcare Commercial |
$2,175.87
|
| Rate for Payer: United Healthcare Medicare |
$1,450.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,450.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.95
|
|
|
HC US ECHOCARDIOGRAPHY WITH CONTRAST
|
Facility
|
IP
|
$2,501.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
483C892901
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,568.13 |
| Max. Negotiated Rate |
$2,501.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,450.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,400.96
|
| Rate for Payer: Altius Commercial |
$2,400.96
|
| Rate for Payer: Beech Street Commercial |
$2,450.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,053.32
|
| Rate for Payer: Cash Price |
$1,750.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,425.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,450.98
|
| Rate for Payer: Entrust Commercial |
$2,375.95
|
| Rate for Payer: First Choice Health Commercial |
$2,375.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,375.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.66
|
| Rate for Payer: HealthUtah PPO |
$2,501.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,425.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,568.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,450.98
|
| Rate for Payer: PacificSource Commercial |
$2,250.90
|
| Rate for Payer: PHCS PPO |
$2,450.98
|
| Rate for Payer: Three Rivers PPO |
$1,875.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.66
|
| Rate for Payer: United Healthcare Commercial |
$2,175.87
|
| Rate for Payer: United Healthcare Medicare |
$1,650.66
|
| Rate for Payer: WINHealth Partners Commercial |
$2,375.95
|
| Rate for Payer: Wise Provider Network Commercial |
$2,375.95
|
|
|
HC US EXAM INFANT HIPS DYNAMIC - XR INFANT HIPS WITH MANIPULATION
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
4027688501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC US EXAM INFANT HIPS DYNAMIC - XR INFANT HIPS WITH MANIPULATION
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
4027688501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC US EXAM INFANT HIPS STATIC - XR INFANT HIPS WITHOUT MANIPULATION
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
4027688601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC US EXAM INFANT HIPS STATIC - XR INFANT HIPS WITHOUT MANIPULATION
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
4027688601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC US EXT NON-VASC LIMITED, REALTIME W/ IMG
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688205
|
|
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 EXT NON-VASC LIMITED, REALTIME W/ IMG
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.21 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$339.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$493.44
|
| Rate for Payer: Altius Commercial |
$493.44
|
| Rate for Payer: Beech Street Commercial |
$503.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.99
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: Entrust Commercial |
$488.30
|
| Rate for Payer: First Choice Health Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.12
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$283.21
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$503.72
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.12
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$298.12
|
| Rate for Payer: WINHealth Partners Commercial |
$503.72
|
| Rate for Payer: Wise Provider Network Commercial |
$488.30
|
|
|
HC US EXT NON-VASC LIMITED, REALTIME W/ IMG
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.28 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$493.44
|
| Rate for Payer: Altius Commercial |
$493.44
|
| Rate for Payer: Beech Street Commercial |
$503.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.99
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: Entrust Commercial |
$488.30
|
| Rate for Payer: First Choice Health Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.24
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$322.28
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$503.72
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$339.24
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$339.24
|
| Rate for Payer: WINHealth Partners Commercial |
$488.30
|
| Rate for Payer: Wise Provider Network Commercial |
$488.30
|
|
|
HC US EXT NON-VASC LIMITED, REALTIME W/ IMG
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688205
|
|
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 GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.12 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.70
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$467.12
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$491.70
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$491.70
|
| Rate for Payer: WINHealth Partners Commercial |
$707.75
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - ASPIRAT OF ABSCESS, HEMATOMA, CYST
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694221
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - ASPIRAT OF ABSCESS, HEMATOMA, CYST
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694221
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.12 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.70
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$467.12
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$491.70
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$491.70
|
| Rate for Payer: WINHealth Partners Commercial |
$707.75
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY BONE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694223
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY BONE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694223
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.12 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.70
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$467.12
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$491.70
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$491.70
|
| Rate for Payer: WINHealth Partners Commercial |
$707.75
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY BONE DEEP
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694224
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY BONE DEEP
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694224
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.12 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.70
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$467.12
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$491.70
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$491.70
|
| Rate for Payer: WINHealth Partners Commercial |
$707.75
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY LYMPH NODE SUPERFICIAL
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694226
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY LYMPH NODE SUPERFICIAL
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694226
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.12 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$491.70
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$467.12
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$491.70
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$491.70
|
| Rate for Payer: WINHealth Partners Commercial |
$707.75
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY PROSTATE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694230
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$730.10
|
| Rate for Payer: Aetna of WY Medicare |
$491.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$715.20
|
| Rate for Payer: Altius Commercial |
$715.20
|
| Rate for Payer: Beech Street Commercial |
$730.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.64
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.65
|
| Rate for Payer: Cigna of WY Commercial |
$730.10
|
| Rate for Payer: Entrust Commercial |
$707.75
|
| Rate for Payer: First Choice Health Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.10
|
| Rate for Payer: HealthUtah PPO |
$745.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.65
|
| Rate for Payer: Multiplan Medicare/VA |
$410.50
|
| Rate for Payer: One Health Plan of WY PPO |
$730.10
|
| Rate for Payer: PacificSource Commercial |
$670.50
|
| Rate for Payer: PHCS PPO |
$730.10
|
| Rate for Payer: Three Rivers PPO |
$558.75
|
| Rate for Payer: TriWest Veterans Administration |
$432.10
|
| Rate for Payer: United Healthcare Commercial |
$648.15
|
| Rate for Payer: United Healthcare Medicare |
$432.10
|
| Rate for Payer: WINHealth Partners Commercial |
$730.10
|
| Rate for Payer: Wise Provider Network Commercial |
$707.75
|
|
