|
HC US GUIDE NDL PLMT IMG S&I - BIOPSY PROSTATE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694230
|
|
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 SENT NODE SPRFCL NOT FNA
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694227
|
|
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 SENT NODE SPRFCL NOT FNA
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694227
|
|
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 - FIDUCIAL MARKER ABDOMEN
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694201
|
|
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 - FIDUCIAL MARKER ABDOMEN
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694201
|
|
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 - FIDUCIAL MARKER ABDOMEN CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694202
|
|
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 - FIDUCIAL MARKER ABDOMEN CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694202
|
|
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 - FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694203
|
|
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 - FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694203
|
|
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 - FINE NEEDLE ASPIRATION CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694204
|
|
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 - FINE NEEDLE ASPIRATION CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694204
|
|
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 - FL GUIDED ASPIRAT OF ABSCESS, HEMATOMA, CYST
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694235
|
|
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 - FL GUIDED ASPIRAT OF ABSCESS, HEMATOMA, CYST
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694235
|
|
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 - FL GUIDED NEEDLE BIOPSY BONE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694237
|
|
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 - FL GUIDED NEEDLE BIOPSY BONE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694237
|
|
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 - FL GUIDED NEEDLE BIOPSY BONE DEEP
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694238
|
|
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 - FL GUIDED NEEDLE BIOPSY BONE DEEP
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694238
|
|
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 - FL GUIDED PERCUTANEOUS NEEDLE BIOPSY MUSCLE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694236
|
|
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 - FL GUIDED PERCUTANEOUS NEEDLE BIOPSY MUSCLE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694236
|
|
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 - FL GUIDED PLEURA NEEDLE BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694239
|
|
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 - FL GUIDED PLEURA NEEDLE BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694239
|
|
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 - INTRAUTERINE TRANSFUSION
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694231
|
|
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 - INTRAUTERINE TRANSFUSION
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694231
|
|
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 - IR PARACENTESIS
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694233
|
|
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 - IR PARACENTESIS
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694233
|
|
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
|
|
