|
HC US, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4027653605
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC US, HEAD/NECK TISSUES,REAL TIME - US HEAD NECK SOFT TISSUE
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4027653605
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.70
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$366.42
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$385.70
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$385.70
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
HC US, HEAD/NECK TISSUES,REAL TIME - US THYROID
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4027653601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.87 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$793.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$777.60
|
| Rate for Payer: Altius Commercial |
$777.60
|
| Rate for Payer: Beech Street Commercial |
$793.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$665.01
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$785.70
|
| Rate for Payer: Cigna of WY Commercial |
$793.80
|
| Rate for Payer: Entrust Commercial |
$769.50
|
| Rate for Payer: First Choice Health Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$534.60
|
| Rate for Payer: HealthUtah PPO |
$810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$785.70
|
| Rate for Payer: Multiplan Medicare/VA |
$507.87
|
| Rate for Payer: One Health Plan of WY PPO |
$793.80
|
| Rate for Payer: PacificSource Commercial |
$729.00
|
| Rate for Payer: PHCS PPO |
$793.80
|
| Rate for Payer: Three Rivers PPO |
$607.50
|
| Rate for Payer: TriWest Veterans Administration |
$534.60
|
| Rate for Payer: United Healthcare Commercial |
$704.70
|
| Rate for Payer: United Healthcare Medicare |
$534.60
|
| Rate for Payer: WINHealth Partners Commercial |
$769.50
|
| Rate for Payer: Wise Provider Network Commercial |
$769.50
|
|
|
HC US, HEAD/NECK TISSUES,REAL TIME - US THYROID
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
4027653601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.31 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$793.80
|
| Rate for Payer: Aetna of WY Medicare |
$534.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$777.60
|
| Rate for Payer: Altius Commercial |
$777.60
|
| Rate for Payer: Beech Street Commercial |
$793.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$665.01
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$785.70
|
| Rate for Payer: Cigna of WY Commercial |
$793.80
|
| Rate for Payer: Entrust Commercial |
$769.50
|
| Rate for Payer: First Choice Health Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$769.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.80
|
| Rate for Payer: HealthUtah PPO |
$810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$785.70
|
| Rate for Payer: Multiplan Medicare/VA |
$446.31
|
| Rate for Payer: One Health Plan of WY PPO |
$793.80
|
| Rate for Payer: PacificSource Commercial |
$729.00
|
| Rate for Payer: PHCS PPO |
$793.80
|
| Rate for Payer: Three Rivers PPO |
$607.50
|
| Rate for Payer: TriWest Veterans Administration |
$469.80
|
| Rate for Payer: United Healthcare Commercial |
$704.70
|
| Rate for Payer: United Healthcare Medicare |
$469.80
|
| Rate for Payer: WINHealth Partners Commercial |
$793.80
|
| Rate for Payer: Wise Provider Network Commercial |
$769.50
|
|
|
HC US, HEAD, REAL TIME - US HEAD
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
4027650602
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC US, HEAD, REAL TIME - US HEAD
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
4027650602
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC US NEEDLE BIOPSY LIVER - NEEDLE BIOPSY, LIVER
|
Facility
|
IP
|
$3,415.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
4024700001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,141.20 |
| Max. Negotiated Rate |
$3,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,346.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,278.40
|
| Rate for Payer: Altius Commercial |
$3,278.40
|
| Rate for Payer: Beech Street Commercial |
$3,346.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,803.72
|
| Rate for Payer: Cash Price |
$2,390.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,312.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,346.70
|
| Rate for Payer: Entrust Commercial |
$3,244.25
|
| Rate for Payer: First Choice Health Commercial |
$3,244.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,244.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,253.90
|
| Rate for Payer: HealthUtah PPO |
$3,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,312.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,141.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3,346.70
|
| Rate for Payer: PacificSource Commercial |
$3,073.50
|
| Rate for Payer: PHCS PPO |
$3,346.70
|
| Rate for Payer: Three Rivers PPO |
$2,561.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,253.90
|
| Rate for Payer: United Healthcare Commercial |
$2,971.05
|
| Rate for Payer: United Healthcare Medicare |
$2,253.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3,244.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,244.25
|
|
|
HC US NEEDLE BIOPSY LIVER - NEEDLE BIOPSY, LIVER
|
Facility
|
OP
|
$3,415.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
4024700001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,881.66 |
| Max. Negotiated Rate |
$3,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,346.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,253.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,278.40
|
| Rate for Payer: Altius Commercial |
$3,278.40
|
| Rate for Payer: Beech Street Commercial |
$3,346.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,803.72
|
| Rate for Payer: Cash Price |
$2,390.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,312.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,346.70
|
| Rate for Payer: Entrust Commercial |
$3,244.25
|
| Rate for Payer: First Choice Health Commercial |
$3,244.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,244.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,980.70
|
| Rate for Payer: HealthUtah PPO |
$3,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,312.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,881.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,346.70
|
| Rate for Payer: PacificSource Commercial |
$3,073.50
|
| Rate for Payer: PHCS PPO |
$3,346.70
|
| Rate for Payer: Three Rivers PPO |
$2,561.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,980.70
|
| Rate for Payer: United Healthcare Commercial |
$2,971.05
|
| Rate for Payer: United Healthcare Medicare |
$1,980.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,346.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3,244.25
|
|
|
HC US PERCUT BX, LUNG/MEDIASTINUM
|
Facility
|
OP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
4023240501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,024.86 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,227.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,785.60
|
| Rate for Payer: Altius Commercial |
$1,785.60
|
| Rate for Payer: Beech Street Commercial |
$1,822.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,527.06
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: Entrust Commercial |
$1,767.00
|
| Rate for Payer: First Choice Health Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,078.80
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,024.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,822.80
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,078.80
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$1,078.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,822.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,767.00
|
|
|
HC US PERCUT BX, LUNG/MEDIASTINUM
|
Facility
|
IP
|
$1,860.00
|
|
|
Service Code
|
HCPCS 32405
|
| Hospital Charge Code |
4023240501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,166.22 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,822.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,785.60
|
| Rate for Payer: Altius Commercial |
$1,785.60
|
| Rate for Payer: Beech Street Commercial |
$1,822.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,527.06
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,804.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,822.80
|
| Rate for Payer: Entrust Commercial |
$1,767.00
|
| Rate for Payer: First Choice Health Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,767.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,227.60
|
| Rate for Payer: HealthUtah PPO |
$1,860.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,804.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,166.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,822.80
|
| Rate for Payer: PacificSource Commercial |
$1,674.00
|
| Rate for Payer: PHCS PPO |
$1,822.80
|
| Rate for Payer: Three Rivers PPO |
$1,395.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,227.60
|
| Rate for Payer: United Healthcare Commercial |
$1,618.20
|
| Rate for Payer: United Healthcare Medicare |
$1,227.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,767.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,767.00
|
|
|
HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
4027677001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Aetna of WY Medicare |
$726.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$606.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,078.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
4027677001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$689.70 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$726.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$689.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC US, RETROPERITNL ABD, LTD - US RETROPERITONEUM LIMITED
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677502
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.05 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$363.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$303.05
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$319.00
|
| Rate for Payer: WINHealth Partners Commercial |
$539.00
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC US, RETROPERITNL ABD, LTD - US RETROPERITONEUM LIMITED
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677502
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$344.85
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
| Rate for Payer: WINHealth Partners Commercial |
$522.50
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC US, RETROPERITNL ABD, LTD - US URINARY BLADDER LIMITED
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.05 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$363.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$303.05
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$319.00
|
| Rate for Payer: WINHealth Partners Commercial |
$539.00
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC US, RETROPERITNL ABD, LTD - US URINARY BLADDER LIMITED
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$344.85
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
| Rate for Payer: WINHealth Partners Commercial |
$522.50
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC US, SPINAL CANAL & CONTENTS - US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
4027680001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Aetna of WY Medicare |
$99.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC US, SPINAL CANAL & CONTENTS - US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
4027680001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.00
|
| Rate for Payer: Altius Commercial |
$144.00
|
| Rate for Payer: Beech Street Commercial |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$145.50
|
| Rate for Payer: Cigna of WY Commercial |
$147.00
|
| Rate for Payer: Entrust Commercial |
$142.50
|
| Rate for Payer: First Choice Health Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$142.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.00
|
| Rate for Payer: HealthUtah PPO |
$150.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$145.50
|
| Rate for Payer: Multiplan Medicare/VA |
$94.05
|
| Rate for Payer: One Health Plan of WY PPO |
$147.00
|
| Rate for Payer: PacificSource Commercial |
$135.00
|
| Rate for Payer: PHCS PPO |
$147.00
|
| Rate for Payer: Three Rivers PPO |
$112.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicare |
$99.00
|
| Rate for Payer: WINHealth Partners Commercial |
$142.50
|
| Rate for Payer: Wise Provider Network Commercial |
$142.50
|
|
|
HC US TEMPERATURE GRADIENT STUDIES RAYNAUD'S EVAL
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 93740
|
| Hospital Charge Code |
4029374001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.80
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$426.36
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$448.80
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$448.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC US TEMPERATURE GRADIENT STUDIES RAYNAUD'S EVAL
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 93740
|
| Hospital Charge Code |
4029374001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Aetna of WY Medicare |
$448.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.40
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$374.68
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$394.40
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$394.40
|
| Rate for Payer: WINHealth Partners Commercial |
$666.40
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER - US KIDNEY TRANSPLANT
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 76776
|
| Hospital Charge Code |
4027677601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Aetna of WY Medicare |
$402.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$585.60
|
| Rate for Payer: Altius Commercial |
$585.60
|
| Rate for Payer: Beech Street Commercial |
$597.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.81
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: Entrust Commercial |
$579.50
|
| Rate for Payer: First Choice Health Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.80
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$336.11
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$597.80
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$353.80
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$353.80
|
| Rate for Payer: WINHealth Partners Commercial |
$597.80
|
| Rate for Payer: Wise Provider Network Commercial |
$579.50
|
|
|
HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER - US KIDNEY TRANSPLANT
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 76776
|
| Hospital Charge Code |
4027677601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$597.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$585.60
|
| Rate for Payer: Altius Commercial |
$585.60
|
| Rate for Payer: Beech Street Commercial |
$597.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.81
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$591.70
|
| Rate for Payer: Cigna of WY Commercial |
$597.80
|
| Rate for Payer: Entrust Commercial |
$579.50
|
| Rate for Payer: First Choice Health Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$579.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$402.60
|
| Rate for Payer: HealthUtah PPO |
$610.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$591.70
|
| Rate for Payer: Multiplan Medicare/VA |
$382.47
|
| Rate for Payer: One Health Plan of WY PPO |
$597.80
|
| Rate for Payer: PacificSource Commercial |
$549.00
|
| Rate for Payer: PHCS PPO |
$597.80
|
| Rate for Payer: Three Rivers PPO |
$457.50
|
| Rate for Payer: TriWest Veterans Administration |
$402.60
|
| Rate for Payer: United Healthcare Commercial |
$530.70
|
| Rate for Payer: United Healthcare Medicare |
$402.60
|
| Rate for Payer: WINHealth Partners Commercial |
$579.50
|
| Rate for Payer: Wise Provider Network Commercial |
$579.50
|
|
|
HC US, UPPER BACK, REAL TIME - US UPPER BACK
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660402
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
