HC US, UPPER BACK, REAL TIME - US UPPER BACK
|
Facility
|
IP
|
$520.00
|
|
Service Code
|
HCPCS 76604
|
Hospital Charge Code |
4027660402
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$326.04 |
Max. Negotiated Rate |
$520.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
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 |
$343.20
|
Rate for Payer: HealthUtah PPO |
$520.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
Rate for Payer: Multiplan Medicare/VA |
$326.04
|
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 |
$343.20
|
Rate for Payer: United Healthcare Commercial |
$452.40
|
Rate for Payer: United Healthcare Medicare |
$343.20
|
Rate for Payer: WINHealth Partners Commercial |
$494.00
|
Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
HC VAGINAL DELIVERY
|
Facility
|
IP
|
$3,280.00
|
|
Hospital Charge Code |
7220000003
|
Hospital Revenue Code
|
722
|
Min. Negotiated Rate |
$2,056.56 |
Max. Negotiated Rate |
$3,280.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,214.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$3,148.80
|
Rate for Payer: Altius Commercial |
$3,148.80
|
Rate for Payer: Beech Street Commercial |
$3,214.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,692.88
|
Rate for Payer: Cash Price |
$2,296.00
|
Rate for Payer: ChoiceCare Network Commercial |
$3,181.60
|
Rate for Payer: Cigna of WY Commercial |
$3,214.40
|
Rate for Payer: Entrust Commercial |
$3,116.00
|
Rate for Payer: First Choice Health Commercial |
$3,116.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,116.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,164.80
|
Rate for Payer: HealthUtah PPO |
$3,280.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,181.60
|
Rate for Payer: Multiplan Medicare/VA |
$2,056.56
|
Rate for Payer: One Health Plan of WY PPO |
$3,214.40
|
Rate for Payer: PacificSource Commercial |
$2,952.00
|
Rate for Payer: PHCS PPO |
$3,214.40
|
Rate for Payer: Three Rivers PPO |
$2,460.00
|
Rate for Payer: TriWest Veterans Administration |
$2,164.80
|
Rate for Payer: United Healthcare Commercial |
$2,853.60
|
Rate for Payer: United Healthcare Medicare |
$2,164.80
|
Rate for Payer: WINHealth Partners Commercial |
$3,116.00
|
Rate for Payer: Wise Provider Network Commercial |
$3,116.00
|
|
HC VAGINAL DELIVERY
|
Facility
|
OP
|
$3,280.00
|
|
Hospital Charge Code |
7220000003
|
Hospital Revenue Code
|
722
|
Min. Negotiated Rate |
$1,807.28 |
Max. Negotiated Rate |
$3,280.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,214.40
|
Rate for Payer: Aetna of WY Medicare |
$2,164.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$3,148.80
|
Rate for Payer: Altius Commercial |
$3,148.80
|
Rate for Payer: Beech Street Commercial |
$3,214.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,692.88
|
Rate for Payer: Cash Price |
$2,296.00
|
Rate for Payer: ChoiceCare Network Commercial |
$3,181.60
|
Rate for Payer: Cigna of WY Commercial |
$3,214.40
|
Rate for Payer: Entrust Commercial |
$3,116.00
|
Rate for Payer: First Choice Health Commercial |
$3,116.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,116.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,902.40
|
Rate for Payer: HealthUtah PPO |
$3,280.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,181.60
|
Rate for Payer: Multiplan Medicare/VA |
$1,807.28
|
Rate for Payer: One Health Plan of WY PPO |
$3,214.40
|
Rate for Payer: PacificSource Commercial |
$2,952.00
|
Rate for Payer: PHCS PPO |
$3,214.40
|
Rate for Payer: Three Rivers PPO |
$2,460.00
|
Rate for Payer: TriWest Veterans Administration |
$1,902.40
|
Rate for Payer: United Healthcare Commercial |
$2,853.60
|
Rate for Payer: United Healthcare Medicare |
$1,902.40
|
Rate for Payer: WINHealth Partners Commercial |
$3,214.40
|
Rate for Payer: Wise Provider Network Commercial |
$3,116.00
|
|
HC VALPROIC ACID (DIPROPYLACETIC ACID); FREE
|
Facility
|
OP
|
$170.00
|
|
Service Code
|
HCPCS 80165
|
Hospital Charge Code |
3018016501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$93.67 |
Max. Negotiated Rate |
$170.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
Rate for Payer: Aetna of WY Medicare |
$112.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
Rate for Payer: Altius Commercial |
$163.20
|
Rate for Payer: Beech Street Commercial |
$166.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
Rate for Payer: Cash Price |
$119.00
|
Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
Rate for Payer: Cigna of WY Commercial |
$166.60
|
Rate for Payer: Entrust Commercial |
$161.50
|
Rate for Payer: First Choice Health Commercial |
$161.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
Rate for Payer: HealthUtah PPO |
$170.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
Rate for Payer: Multiplan Medicare/VA |
$93.67
|
Rate for Payer: One Health Plan of WY PPO |
$166.60
|
Rate for Payer: PacificSource Commercial |
$153.00
|
Rate for Payer: PHCS PPO |
$166.60
|
Rate for Payer: Three Rivers PPO |
$127.50
|
Rate for Payer: TriWest Veterans Administration |
$98.60
|
Rate for Payer: United Healthcare Commercial |
$147.90
|
Rate for Payer: United Healthcare Medicare |
$98.60
|
Rate for Payer: WINHealth Partners Commercial |
$166.60
|
Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
HC VALPROIC ACID (DIPROPYLACETIC ACID); FREE
|
Facility
|
IP
|
$170.00
|
|
Service Code
|
HCPCS 80165
|
Hospital Charge Code |
3018016501
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$106.59 |
Max. Negotiated Rate |
$170.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
Rate for Payer: Altius Commercial |
$163.20
|
Rate for Payer: Beech Street Commercial |
$166.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
Rate for Payer: Cash Price |
$119.00
|
Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
Rate for Payer: Cigna of WY Commercial |
$166.60
|
Rate for Payer: Entrust Commercial |
$161.50
|
Rate for Payer: First Choice Health Commercial |
$161.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
Rate for Payer: HealthUtah PPO |
$170.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
Rate for Payer: Multiplan Medicare/VA |
$106.59
|
Rate for Payer: One Health Plan of WY PPO |
$166.60
|
Rate for Payer: PacificSource Commercial |
$153.00
|
Rate for Payer: PHCS PPO |
$166.60
|
Rate for Payer: Three Rivers PPO |
$127.50
|
Rate for Payer: TriWest Veterans Administration |
$112.20
|
Rate for Payer: United Healthcare Commercial |
$147.90
|
Rate for Payer: United Healthcare Medicare |
$112.20
|
Rate for Payer: WINHealth Partners Commercial |
$161.50
|
Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
HC VARICELLA AG, DFA - VARICELLA ZOSTER DFA
|
Facility
|
OP
|
$190.00
|
|
Service Code
|
HCPCS 87290
|
Hospital Charge Code |
3068729001
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$104.69 |
Max. Negotiated Rate |
$190.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
Rate for Payer: Aetna of WY Medicare |
$125.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
Rate for Payer: Altius Commercial |
$182.40
|
Rate for Payer: Beech Street Commercial |
$186.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
Rate for Payer: Cash Price |
$133.00
|
Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
Rate for Payer: Cigna of WY Commercial |
$186.20
|
Rate for Payer: Entrust Commercial |
$180.50
|
Rate for Payer: First Choice Health Commercial |
$180.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.20
|
Rate for Payer: HealthUtah PPO |
$190.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
Rate for Payer: Multiplan Medicare/VA |
$104.69
|
Rate for Payer: One Health Plan of WY PPO |
$186.20
|
Rate for Payer: PacificSource Commercial |
$171.00
|
Rate for Payer: PHCS PPO |
$186.20
|
Rate for Payer: Three Rivers PPO |
$142.50
|
Rate for Payer: TriWest Veterans Administration |
$110.20
|
Rate for Payer: United Healthcare Commercial |
$165.30
|
Rate for Payer: United Healthcare Medicare |
$110.20
|
Rate for Payer: WINHealth Partners Commercial |
$186.20
|
Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
HC VARICELLA AG, DFA - VARICELLA ZOSTER DFA
|
Facility
|
IP
|
$190.00
|
|
Service Code
|
HCPCS 87290
|
Hospital Charge Code |
3068729001
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$119.13 |
Max. Negotiated Rate |
$190.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$182.40
|
Rate for Payer: Altius Commercial |
$182.40
|
Rate for Payer: Beech Street Commercial |
$186.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.99
|
Rate for Payer: Cash Price |
$133.00
|
Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
Rate for Payer: Cigna of WY Commercial |
$186.20
|
Rate for Payer: Entrust Commercial |
$180.50
|
Rate for Payer: First Choice Health Commercial |
$180.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.40
|
Rate for Payer: HealthUtah PPO |
$190.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
Rate for Payer: Multiplan Medicare/VA |
$119.13
|
Rate for Payer: One Health Plan of WY PPO |
$186.20
|
Rate for Payer: PacificSource Commercial |
$171.00
|
Rate for Payer: PHCS PPO |
$186.20
|
Rate for Payer: Three Rivers PPO |
$142.50
|
Rate for Payer: TriWest Veterans Administration |
$125.40
|
Rate for Payer: United Healthcare Commercial |
$165.30
|
Rate for Payer: United Healthcare Medicare |
$125.40
|
Rate for Payer: WINHealth Partners Commercial |
$180.50
|
Rate for Payer: Wise Provider Network Commercial |
$180.50
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$145.00
|
|
Service Code
|
HCPCS 86787
|
Hospital Charge Code |
3028678701
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$79.90 |
Max. Negotiated Rate |
$145.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
Rate for Payer: Aetna of WY Medicare |
$95.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
Rate for Payer: Altius Commercial |
$139.20
|
Rate for Payer: Beech Street Commercial |
$142.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
Rate for Payer: Cigna of WY Commercial |
$142.10
|
Rate for Payer: Entrust Commercial |
$137.75
|
Rate for Payer: First Choice Health Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.10
|
Rate for Payer: HealthUtah PPO |
$145.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
Rate for Payer: Multiplan Medicare/VA |
$79.90
|
Rate for Payer: One Health Plan of WY PPO |
$142.10
|
Rate for Payer: PacificSource Commercial |
$130.50
|
Rate for Payer: PHCS PPO |
$142.10
|
Rate for Payer: Three Rivers PPO |
$108.75
|
Rate for Payer: TriWest Veterans Administration |
$84.10
|
Rate for Payer: United Healthcare Commercial |
$126.15
|
Rate for Payer: United Healthcare Medicare |
$84.10
|
Rate for Payer: WINHealth Partners Commercial |
$142.10
|
Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$145.00
|
|
Service Code
|
HCPCS 86787
|
Hospital Charge Code |
3028678701
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$90.92 |
Max. Negotiated Rate |
$145.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
Rate for Payer: Altius Commercial |
$139.20
|
Rate for Payer: Beech Street Commercial |
$142.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
Rate for Payer: Cigna of WY Commercial |
$142.10
|
Rate for Payer: Entrust Commercial |
$137.75
|
Rate for Payer: First Choice Health Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
Rate for Payer: HealthUtah PPO |
$145.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
Rate for Payer: Multiplan Medicare/VA |
$90.92
|
Rate for Payer: One Health Plan of WY PPO |
$142.10
|
Rate for Payer: PacificSource Commercial |
$130.50
|
Rate for Payer: PHCS PPO |
$142.10
|
Rate for Payer: Three Rivers PPO |
$108.75
|
Rate for Payer: TriWest Veterans Administration |
$95.70
|
Rate for Payer: United Healthcare Commercial |
$126.15
|
Rate for Payer: United Healthcare Medicare |
$95.70
|
Rate for Payer: WINHealth Partners Commercial |
$137.75
|
Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$145.00
|
|
Service Code
|
HCPCS 86787
|
Hospital Charge Code |
3028678702
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$79.90 |
Max. Negotiated Rate |
$145.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
Rate for Payer: Aetna of WY Medicare |
$95.70
|
Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
Rate for Payer: Altius Commercial |
$139.20
|
Rate for Payer: Beech Street Commercial |
$142.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
Rate for Payer: Cigna of WY Commercial |
$142.10
|
Rate for Payer: Entrust Commercial |
$137.75
|
Rate for Payer: First Choice Health Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.10
|
Rate for Payer: HealthUtah PPO |
$145.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
Rate for Payer: Multiplan Medicare/VA |
$79.90
|
Rate for Payer: One Health Plan of WY PPO |
$142.10
|
Rate for Payer: PacificSource Commercial |
$130.50
|
Rate for Payer: PHCS PPO |
$142.10
|
Rate for Payer: Three Rivers PPO |
$108.75
|
Rate for Payer: TriWest Veterans Administration |
$84.10
|
Rate for Payer: United Healthcare Commercial |
$126.15
|
Rate for Payer: United Healthcare Medicare |
$84.10
|
Rate for Payer: WINHealth Partners Commercial |
$142.10
|
Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$145.00
|
|
Service Code
|
HCPCS 86787
|
Hospital Charge Code |
3028678702
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$90.92 |
Max. Negotiated Rate |
$145.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
Rate for Payer: Altius Commercial |
$139.20
|
Rate for Payer: Beech Street Commercial |
$142.10
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
Rate for Payer: Cigna of WY Commercial |
$142.10
|
Rate for Payer: Entrust Commercial |
$137.75
|
Rate for Payer: First Choice Health Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
Rate for Payer: HealthUtah PPO |
$145.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
Rate for Payer: Multiplan Medicare/VA |
$90.92
|
Rate for Payer: One Health Plan of WY PPO |
$142.10
|
Rate for Payer: PacificSource Commercial |
$130.50
|
Rate for Payer: PHCS PPO |
$142.10
|
Rate for Payer: Three Rivers PPO |
$108.75
|
Rate for Payer: TriWest Veterans Administration |
$95.70
|
Rate for Payer: United Healthcare Commercial |
$126.15
|
Rate for Payer: United Healthcare Medicare |
$95.70
|
Rate for Payer: WINHealth Partners Commercial |
$137.75
|
Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
OP
|
$1,000.00
|
|
Service Code
|
HCPCS 93975
|
Hospital Charge Code |
9219397504
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$551.00 |
Max. Negotiated Rate |
$1,000.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$980.00
|
Rate for Payer: Aetna of WY Medicare |
$660.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$960.00
|
Rate for Payer: Altius Commercial |
$960.00
|
Rate for Payer: Beech Street Commercial |
$980.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: ChoiceCare Network Commercial |
$970.00
|
Rate for Payer: Cigna of WY Commercial |
$980.00
|
Rate for Payer: Entrust Commercial |
$950.00
|
Rate for Payer: First Choice Health Commercial |
$950.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$950.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$580.00
|
Rate for Payer: HealthUtah PPO |
$1,000.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$970.00
|
Rate for Payer: Multiplan Medicare/VA |
$551.00
|
Rate for Payer: One Health Plan of WY PPO |
$980.00
|
Rate for Payer: PacificSource Commercial |
$900.00
|
Rate for Payer: PHCS PPO |
$980.00
|
Rate for Payer: Three Rivers PPO |
$750.00
|
Rate for Payer: TriWest Veterans Administration |
$580.00
|
Rate for Payer: United Healthcare Commercial |
$870.00
|
Rate for Payer: United Healthcare Medicare |
$580.00
|
Rate for Payer: WINHealth Partners Commercial |
$980.00
|
Rate for Payer: Wise Provider Network Commercial |
$950.00
|
|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
IP
|
$1,000.00
|
|
Service Code
|
HCPCS 93975
|
Hospital Charge Code |
9219397504
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$627.00 |
Max. Negotiated Rate |
$1,000.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$980.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$960.00
|
Rate for Payer: Altius Commercial |
$960.00
|
Rate for Payer: Beech Street Commercial |
$980.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: ChoiceCare Network Commercial |
$970.00
|
Rate for Payer: Cigna of WY Commercial |
$980.00
|
Rate for Payer: Entrust Commercial |
$950.00
|
Rate for Payer: First Choice Health Commercial |
$950.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$950.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.00
|
Rate for Payer: HealthUtah PPO |
$1,000.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$970.00
|
Rate for Payer: Multiplan Medicare/VA |
$627.00
|
Rate for Payer: One Health Plan of WY PPO |
$980.00
|
Rate for Payer: PacificSource Commercial |
$900.00
|
Rate for Payer: PHCS PPO |
$980.00
|
Rate for Payer: Three Rivers PPO |
$750.00
|
Rate for Payer: TriWest Veterans Administration |
$660.00
|
Rate for Payer: United Healthcare Commercial |
$870.00
|
Rate for Payer: United Healthcare Medicare |
$660.00
|
Rate for Payer: WINHealth Partners Commercial |
$950.00
|
Rate for Payer: Wise Provider Network Commercial |
$950.00
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
IP
|
$1,580.00
|
|
Service Code
|
HCPCS 93970
|
Hospital Charge Code |
9219397006
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$990.66 |
Max. Negotiated Rate |
$1,580.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,516.80
|
Rate for Payer: Altius Commercial |
$1,516.80
|
Rate for Payer: Beech Street Commercial |
$1,548.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,297.18
|
Rate for Payer: Cash Price |
$1,106.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
Rate for Payer: Entrust Commercial |
$1,501.00
|
Rate for Payer: First Choice Health Commercial |
$1,501.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,042.80
|
Rate for Payer: HealthUtah PPO |
$1,580.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
Rate for Payer: Multiplan Medicare/VA |
$990.66
|
Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
Rate for Payer: PacificSource Commercial |
$1,422.00
|
Rate for Payer: PHCS PPO |
$1,548.40
|
Rate for Payer: Three Rivers PPO |
$1,185.00
|
Rate for Payer: TriWest Veterans Administration |
$1,042.80
|
Rate for Payer: United Healthcare Commercial |
$1,374.60
|
Rate for Payer: United Healthcare Medicare |
$1,042.80
|
Rate for Payer: WINHealth Partners Commercial |
$1,501.00
|
Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
OP
|
$1,580.00
|
|
Service Code
|
HCPCS 93970
|
Hospital Charge Code |
9219397006
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$870.58 |
Max. Negotiated Rate |
$1,580.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,548.40
|
Rate for Payer: Aetna of WY Medicare |
$1,042.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,516.80
|
Rate for Payer: Altius Commercial |
$1,516.80
|
Rate for Payer: Beech Street Commercial |
$1,548.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,297.18
|
Rate for Payer: Cash Price |
$1,106.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,532.60
|
Rate for Payer: Cigna of WY Commercial |
$1,548.40
|
Rate for Payer: Entrust Commercial |
$1,501.00
|
Rate for Payer: First Choice Health Commercial |
$1,501.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,501.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$916.40
|
Rate for Payer: HealthUtah PPO |
$1,580.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,532.60
|
Rate for Payer: Multiplan Medicare/VA |
$870.58
|
Rate for Payer: One Health Plan of WY PPO |
$1,548.40
|
Rate for Payer: PacificSource Commercial |
$1,422.00
|
Rate for Payer: PHCS PPO |
$1,548.40
|
Rate for Payer: Three Rivers PPO |
$1,185.00
|
Rate for Payer: TriWest Veterans Administration |
$916.40
|
Rate for Payer: United Healthcare Commercial |
$1,374.60
|
Rate for Payer: United Healthcare Medicare |
$916.40
|
Rate for Payer: WINHealth Partners Commercial |
$1,548.40
|
Rate for Payer: Wise Provider Network Commercial |
$1,501.00
|
|
HC VASC DUPLEX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$460.00
|
|
Service Code
|
HCPCS 93990
|
Hospital Charge Code |
9219399002
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$288.42 |
Max. Negotiated Rate |
$460.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
Rate for Payer: Altius Commercial |
$441.60
|
Rate for Payer: Beech Street Commercial |
$450.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
Rate for Payer: Cash Price |
$322.00
|
Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
Rate for Payer: Cigna of WY Commercial |
$450.80
|
Rate for Payer: Entrust Commercial |
$437.00
|
Rate for Payer: First Choice Health Commercial |
$437.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.60
|
Rate for Payer: HealthUtah PPO |
$460.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
Rate for Payer: Multiplan Medicare/VA |
$288.42
|
Rate for Payer: One Health Plan of WY PPO |
$450.80
|
Rate for Payer: PacificSource Commercial |
$414.00
|
Rate for Payer: PHCS PPO |
$450.80
|
Rate for Payer: Three Rivers PPO |
$345.00
|
Rate for Payer: TriWest Veterans Administration |
$303.60
|
Rate for Payer: United Healthcare Commercial |
$400.20
|
Rate for Payer: United Healthcare Medicare |
$303.60
|
Rate for Payer: WINHealth Partners Commercial |
$437.00
|
Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
HC VASC DUPLEX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$460.00
|
|
Service Code
|
HCPCS 93990
|
Hospital Charge Code |
9219399002
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$253.46 |
Max. Negotiated Rate |
$460.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
Rate for Payer: Aetna of WY Medicare |
$303.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
Rate for Payer: Altius Commercial |
$441.60
|
Rate for Payer: Beech Street Commercial |
$450.80
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
Rate for Payer: Cash Price |
$322.00
|
Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
Rate for Payer: Cigna of WY Commercial |
$450.80
|
Rate for Payer: Entrust Commercial |
$437.00
|
Rate for Payer: First Choice Health Commercial |
$437.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.80
|
Rate for Payer: HealthUtah PPO |
$460.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
Rate for Payer: Multiplan Medicare/VA |
$253.46
|
Rate for Payer: One Health Plan of WY PPO |
$450.80
|
Rate for Payer: PacificSource Commercial |
$414.00
|
Rate for Payer: PHCS PPO |
$450.80
|
Rate for Payer: Three Rivers PPO |
$345.00
|
Rate for Payer: TriWest Veterans Administration |
$266.80
|
Rate for Payer: United Healthcare Commercial |
$400.20
|
Rate for Payer: United Healthcare Medicare |
$266.80
|
Rate for Payer: WINHealth Partners Commercial |
$450.80
|
Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
OP
|
$900.00
|
|
Service Code
|
HCPCS 93926
|
Hospital Charge Code |
9219392603
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$495.90 |
Max. Negotiated Rate |
$900.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
Rate for Payer: Aetna of WY Medicare |
$594.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
Rate for Payer: Altius Commercial |
$864.00
|
Rate for Payer: Beech Street Commercial |
$882.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
Rate for Payer: Cash Price |
$630.00
|
Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
Rate for Payer: Cigna of WY Commercial |
$882.00
|
Rate for Payer: Entrust Commercial |
$855.00
|
Rate for Payer: First Choice Health Commercial |
$855.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.00
|
Rate for Payer: HealthUtah PPO |
$900.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
Rate for Payer: Multiplan Medicare/VA |
$495.90
|
Rate for Payer: One Health Plan of WY PPO |
$882.00
|
Rate for Payer: PacificSource Commercial |
$810.00
|
Rate for Payer: PHCS PPO |
$882.00
|
Rate for Payer: Three Rivers PPO |
$675.00
|
Rate for Payer: TriWest Veterans Administration |
$522.00
|
Rate for Payer: United Healthcare Commercial |
$783.00
|
Rate for Payer: United Healthcare Medicare |
$522.00
|
Rate for Payer: WINHealth Partners Commercial |
$882.00
|
Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
IP
|
$900.00
|
|
Service Code
|
HCPCS 93926
|
Hospital Charge Code |
9219392603
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$564.30 |
Max. Negotiated Rate |
$900.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
Rate for Payer: Altius Commercial |
$864.00
|
Rate for Payer: Beech Street Commercial |
$882.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
Rate for Payer: Cash Price |
$630.00
|
Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
Rate for Payer: Cigna of WY Commercial |
$882.00
|
Rate for Payer: Entrust Commercial |
$855.00
|
Rate for Payer: First Choice Health Commercial |
$855.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.00
|
Rate for Payer: HealthUtah PPO |
$900.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
Rate for Payer: Multiplan Medicare/VA |
$564.30
|
Rate for Payer: One Health Plan of WY PPO |
$882.00
|
Rate for Payer: PacificSource Commercial |
$810.00
|
Rate for Payer: PHCS PPO |
$882.00
|
Rate for Payer: Three Rivers PPO |
$675.00
|
Rate for Payer: TriWest Veterans Administration |
$594.00
|
Rate for Payer: United Healthcare Commercial |
$783.00
|
Rate for Payer: United Healthcare Medicare |
$594.00
|
Rate for Payer: WINHealth Partners Commercial |
$855.00
|
Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
OP
|
$930.00
|
|
Service Code
|
HCPCS 93930
|
Hospital Charge Code |
9219393006
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$512.43 |
Max. Negotiated Rate |
$930.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
Rate for Payer: Aetna of WY Medicare |
$613.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
Rate for Payer: Altius Commercial |
$892.80
|
Rate for Payer: Beech Street Commercial |
$911.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
Rate for Payer: Cash Price |
$651.00
|
Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
Rate for Payer: Cigna of WY Commercial |
$911.40
|
Rate for Payer: Entrust Commercial |
$883.50
|
Rate for Payer: First Choice Health Commercial |
$883.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.40
|
Rate for Payer: HealthUtah PPO |
$930.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
Rate for Payer: Multiplan Medicare/VA |
$512.43
|
Rate for Payer: One Health Plan of WY PPO |
$911.40
|
Rate for Payer: PacificSource Commercial |
$837.00
|
Rate for Payer: PHCS PPO |
$911.40
|
Rate for Payer: Three Rivers PPO |
$697.50
|
Rate for Payer: TriWest Veterans Administration |
$539.40
|
Rate for Payer: United Healthcare Commercial |
$809.10
|
Rate for Payer: United Healthcare Medicare |
$539.40
|
Rate for Payer: WINHealth Partners Commercial |
$911.40
|
Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
IP
|
$930.00
|
|
Service Code
|
HCPCS 93930
|
Hospital Charge Code |
9219393006
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$583.11 |
Max. Negotiated Rate |
$930.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
Rate for Payer: Altius Commercial |
$892.80
|
Rate for Payer: Beech Street Commercial |
$911.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
Rate for Payer: Cash Price |
$651.00
|
Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
Rate for Payer: Cigna of WY Commercial |
$911.40
|
Rate for Payer: Entrust Commercial |
$883.50
|
Rate for Payer: First Choice Health Commercial |
$883.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$613.80
|
Rate for Payer: HealthUtah PPO |
$930.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
Rate for Payer: Multiplan Medicare/VA |
$583.11
|
Rate for Payer: One Health Plan of WY PPO |
$911.40
|
Rate for Payer: PacificSource Commercial |
$837.00
|
Rate for Payer: PHCS PPO |
$911.40
|
Rate for Payer: Three Rivers PPO |
$697.50
|
Rate for Payer: TriWest Veterans Administration |
$613.80
|
Rate for Payer: United Healthcare Commercial |
$809.10
|
Rate for Payer: United Healthcare Medicare |
$613.80
|
Rate for Payer: WINHealth Partners Commercial |
$883.50
|
Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
HC VASC NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL
|
Facility
|
OP
|
$570.00
|
|
Service Code
|
HCPCS 93924
|
Hospital Charge Code |
9219392401
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$314.07 |
Max. Negotiated Rate |
$570.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
Rate for Payer: Aetna of WY Medicare |
$376.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
Rate for Payer: Altius Commercial |
$547.20
|
Rate for Payer: Beech Street Commercial |
$558.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
Rate for Payer: Cash Price |
$399.00
|
Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
Rate for Payer: Cigna of WY Commercial |
$558.60
|
Rate for Payer: Entrust Commercial |
$541.50
|
Rate for Payer: First Choice Health Commercial |
$541.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.60
|
Rate for Payer: HealthUtah PPO |
$570.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
Rate for Payer: Multiplan Medicare/VA |
$314.07
|
Rate for Payer: One Health Plan of WY PPO |
$558.60
|
Rate for Payer: PacificSource Commercial |
$513.00
|
Rate for Payer: PHCS PPO |
$558.60
|
Rate for Payer: Three Rivers PPO |
$427.50
|
Rate for Payer: TriWest Veterans Administration |
$330.60
|
Rate for Payer: United Healthcare Commercial |
$495.90
|
Rate for Payer: United Healthcare Medicare |
$330.60
|
Rate for Payer: WINHealth Partners Commercial |
$558.60
|
Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
HC VASC NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL
|
Facility
|
IP
|
$570.00
|
|
Service Code
|
HCPCS 93924
|
Hospital Charge Code |
9219392401
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$357.39 |
Max. Negotiated Rate |
$570.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
Rate for Payer: Altius Commercial |
$547.20
|
Rate for Payer: Beech Street Commercial |
$558.60
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
Rate for Payer: Cash Price |
$399.00
|
Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
Rate for Payer: Cigna of WY Commercial |
$558.60
|
Rate for Payer: Entrust Commercial |
$541.50
|
Rate for Payer: First Choice Health Commercial |
$541.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.20
|
Rate for Payer: HealthUtah PPO |
$570.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
Rate for Payer: Multiplan Medicare/VA |
$357.39
|
Rate for Payer: One Health Plan of WY PPO |
$558.60
|
Rate for Payer: PacificSource Commercial |
$513.00
|
Rate for Payer: PHCS PPO |
$558.60
|
Rate for Payer: Three Rivers PPO |
$427.50
|
Rate for Payer: TriWest Veterans Administration |
$376.20
|
Rate for Payer: United Healthcare Commercial |
$495.90
|
Rate for Payer: United Healthcare Medicare |
$376.20
|
Rate for Payer: WINHealth Partners Commercial |
$541.50
|
Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
HC VASC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL
|
Facility
|
OP
|
$700.00
|
|
Service Code
|
HCPCS 93922
|
Hospital Charge Code |
9219392203
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$385.70 |
Max. Negotiated Rate |
$700.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
Rate for Payer: Aetna of WY Medicare |
$462.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
Rate for Payer: Altius Commercial |
$672.00
|
Rate for Payer: Beech Street Commercial |
$686.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
Rate for Payer: Cash Price |
$490.00
|
Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
Rate for Payer: Cigna of WY Commercial |
$686.00
|
Rate for Payer: Entrust Commercial |
$665.00
|
Rate for Payer: First Choice Health Commercial |
$665.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.00
|
Rate for Payer: HealthUtah PPO |
$700.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
Rate for Payer: Multiplan Medicare/VA |
$385.70
|
Rate for Payer: One Health Plan of WY PPO |
$686.00
|
Rate for Payer: PacificSource Commercial |
$630.00
|
Rate for Payer: PHCS PPO |
$686.00
|
Rate for Payer: Three Rivers PPO |
$525.00
|
Rate for Payer: TriWest Veterans Administration |
$406.00
|
Rate for Payer: United Healthcare Commercial |
$609.00
|
Rate for Payer: United Healthcare Medicare |
$406.00
|
Rate for Payer: WINHealth Partners Commercial |
$686.00
|
Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|
HC VASC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL
|
Facility
|
IP
|
$700.00
|
|
Service Code
|
HCPCS 93922
|
Hospital Charge Code |
9219392203
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$438.90 |
Max. Negotiated Rate |
$700.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$672.00
|
Rate for Payer: Altius Commercial |
$672.00
|
Rate for Payer: Beech Street Commercial |
$686.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$574.70
|
Rate for Payer: Cash Price |
$490.00
|
Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
Rate for Payer: Cigna of WY Commercial |
$686.00
|
Rate for Payer: Entrust Commercial |
$665.00
|
Rate for Payer: First Choice Health Commercial |
$665.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.00
|
Rate for Payer: HealthUtah PPO |
$700.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
Rate for Payer: Multiplan Medicare/VA |
$438.90
|
Rate for Payer: One Health Plan of WY PPO |
$686.00
|
Rate for Payer: PacificSource Commercial |
$630.00
|
Rate for Payer: PHCS PPO |
$686.00
|
Rate for Payer: Three Rivers PPO |
$525.00
|
Rate for Payer: TriWest Veterans Administration |
$462.00
|
Rate for Payer: United Healthcare Commercial |
$609.00
|
Rate for Payer: United Healthcare Medicare |
$462.00
|
Rate for Payer: WINHealth Partners Commercial |
$665.00
|
Rate for Payer: Wise Provider Network Commercial |
$665.00
|
|