|
HC US GUIDE NDL PLMT IMG S&I - IR PARACENTESIS CHARGE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694241
|
|
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 - IR PARACENTESIS CHARGE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694241
|
|
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 PERC NEEDLE BIOPSY PANCREAS W US GUIDANCE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694240
|
|
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 - IR PERC NEEDLE BIOPSY PANCREAS W US GUIDANCE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694240
|
|
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 THORACENTESIS
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694234
|
|
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 - IR THORACENTESIS
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694234
|
|
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 THORACENTESIS CHARGE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694242
|
|
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 THORACENTESIS CHARGE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694242
|
|
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 - KIDNEY BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694205
|
|
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 - KIDNEY BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694205
|
|
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 - LIVER BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694220
|
|
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 - LIVER BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694220
|
|
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 - PERC NEEDLE BIOPSY PANCREAS
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694229
|
|
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 - PERC NEEDLE BIOPSY PANCREAS
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694229
|
|
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 - PERCUTANEOUS BIOPSY RENAL LEFT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694206
|
|
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 - PERCUTANEOUS BIOPSY RENAL LEFT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694206
|
|
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 - PERCUTANEOUS BIOPSY RENAL LEFT CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694207
|
|
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 - PERCUTANEOUS BIOPSY RENAL LEFT CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694207
|
|
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 - PERCUTANEOUS BIOPSY RENAL RIGHT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694208
|
|
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 - PERCUTANEOUS BIOPSY RENAL RIGHT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694208
|
|
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 - PERCUTANEOUS BIOPSY RENAL RT CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694209
|
|
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 - PERCUTANEOUS BIOPSY RENAL RT CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694209
|
|
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 - PERCUTANEOUS NEEDLE BIOPSY MUSCLE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694222
|
|
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 - PERCUTANEOUS NEEDLE BIOPSY MUSCLE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694222
|
|
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 - PLEURA NEEDLE BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694225
|
|
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
|
|
