|
HC US GUIDE NDL PLMT IMG S&I - PLEURA NEEDLE BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694225
|
|
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 - PSEUDOANEURYSM THROMBIN INJ CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694210
|
|
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 - PSEUDOANEURYSM THROMBIN INJ CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694210
|
|
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 - PSEUDOANEURYSM THROMBIN INJECTION
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694211
|
|
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 - PSEUDOANEURYSM THROMBIN INJECTION
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694211
|
|
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 - RENAL CYST ASPIRATION BILAT CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694212
|
|
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 - RENAL CYST ASPIRATION BILAT CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694212
|
|
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 - RENAL CYST ASPIRATION BILATERAL
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694213
|
|
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 - RENAL CYST ASPIRATION BILATERAL
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694213
|
|
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 - RENAL CYST ASPIRATION LEFT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694214
|
|
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 - RENAL CYST ASPIRATION LEFT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694214
|
|
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 - RENAL CYST ASPIRATION LEFT CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694215
|
|
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 - RENAL CYST ASPIRATION LEFT CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694215
|
|
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 - RENAL CYST ASPIRATION RIGHT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694216
|
|
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 - RENAL CYST ASPIRATION RIGHT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694216
|
|
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 - RENAL CYST ASPIRATION RIGHT CHG
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694217
|
|
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 - RENAL CYST ASPIRATION RIGHT CHG
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694217
|
|
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 - SALIVARY GLAND BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694228
|
|
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 - SALIVARY GLAND BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694228
|
|
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 - SOFT TISSUE BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694219
|
|
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 - SOFT TISSUE BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694219
|
|
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 - THYROID BIOPSY
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694218
|
|
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 - THYROID BIOPSY
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
4027694218
|
|
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, VASCULAR ACCESS - XR PICC LINE VASCULARE INSERTION
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
4027693701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.70
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$279.02
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$293.70
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$293.70
|
| Rate for Payer: WINHealth Partners Commercial |
$422.75
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC US GUIDE, VASCULAR ACCESS - XR PICC LINE VASCULARE INSERTION
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
4027693701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$293.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.10
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$245.20
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$258.10
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$258.10
|
| Rate for Payer: WINHealth Partners Commercial |
$436.10
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
