|
HC BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
5105750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Aetna of WY Medicare |
$50.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.08
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$41.88
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.08
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$44.08
|
| Rate for Payer: WINHealth Partners Commercial |
$74.48
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC BIOPSY, EACH ADDED LESION
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 11101
|
| Hospital Charge Code |
5101110101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.82
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.93
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC BIOPSY, EACH ADDED LESION
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 11101
|
| Hospital Charge Code |
5101110101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Aetna of WY Medicare |
$17.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.92
|
| Rate for Payer: Altius Commercial |
$25.92
|
| Rate for Payer: Beech Street Commercial |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: Entrust Commercial |
$25.65
|
| Rate for Payer: First Choice Health Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.66
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$26.46
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$15.66
|
| Rate for Payer: WINHealth Partners Commercial |
$26.46
|
| Rate for Payer: Wise Provider Network Commercial |
$25.65
|
|
|
HC BIOPSY EXTERNAL AUDITORY CANAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
5106910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.44
|
| Rate for Payer: Altius Commercial |
$61.44
|
| Rate for Payer: Beech Street Commercial |
$62.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.54
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: Entrust Commercial |
$60.80
|
| Rate for Payer: First Choice Health Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.24
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: Multiplan Medicare/VA |
$40.13
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$62.72
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.24
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: United Healthcare Medicare |
$42.24
|
| Rate for Payer: WINHealth Partners Commercial |
$60.80
|
| Rate for Payer: Wise Provider Network Commercial |
$60.80
|
|
|
HC BIOPSY EXTERNAL AUDITORY CANAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 69105
|
| Hospital Charge Code |
5106910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Aetna of WY Medicare |
$42.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.44
|
| Rate for Payer: Altius Commercial |
$61.44
|
| Rate for Payer: Beech Street Commercial |
$62.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.54
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: Entrust Commercial |
$60.80
|
| Rate for Payer: First Choice Health Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: Multiplan Medicare/VA |
$35.26
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$62.72
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: WINHealth Partners Commercial |
$62.72
|
| Rate for Payer: Wise Provider Network Commercial |
$60.80
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
5106910001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.34
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$30.72
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.34
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$32.34
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 69100
|
| Hospital Charge Code |
5106910001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.42
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$27.00
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.42
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$28.42
|
| Rate for Payer: WINHealth Partners Commercial |
$48.02
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
|
HC BIOPSY INTRANASAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
5103010001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Aetna of WY Medicare |
$64.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.08
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.46
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.84
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$54.00
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.84
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$56.84
|
| Rate for Payer: WINHealth Partners Commercial |
$96.04
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC BIOPSY INTRANASAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
5103010001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$96.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.08
|
| Rate for Payer: Altius Commercial |
$94.08
|
| Rate for Payer: Beech Street Commercial |
$96.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.46
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$95.06
|
| Rate for Payer: Cigna of WY Commercial |
$96.04
|
| Rate for Payer: Entrust Commercial |
$93.10
|
| Rate for Payer: First Choice Health Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.68
|
| Rate for Payer: HealthUtah PPO |
$98.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$95.06
|
| Rate for Payer: Multiplan Medicare/VA |
$61.45
|
| Rate for Payer: One Health Plan of WY PPO |
$96.04
|
| Rate for Payer: PacificSource Commercial |
$88.20
|
| Rate for Payer: PHCS PPO |
$96.04
|
| Rate for Payer: Three Rivers PPO |
$73.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.68
|
| Rate for Payer: United Healthcare Commercial |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$64.68
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$93.10
|
|
|
HC BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3205020001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,774.35 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Aetna of WY Medicare |
$4,521.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,973.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,774.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,973.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$3,973.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,713.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC BIOPSY OF KIDNEY,PERCUTANEOUS
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
3205020001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,294.95 |
| Max. Negotiated Rate |
$6,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,713.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,576.00
|
| Rate for Payer: Altius Commercial |
$6,576.00
|
| Rate for Payer: Beech Street Commercial |
$6,713.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,623.85
|
| Rate for Payer: Cash Price |
$4,795.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,644.50
|
| Rate for Payer: Cigna of WY Commercial |
$6,713.00
|
| Rate for Payer: Entrust Commercial |
$6,507.50
|
| Rate for Payer: First Choice Health Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,521.00
|
| Rate for Payer: HealthUtah PPO |
$6,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,644.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4,294.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,713.00
|
| Rate for Payer: PacificSource Commercial |
$6,165.00
|
| Rate for Payer: PHCS PPO |
$6,713.00
|
| Rate for Payer: Three Rivers PPO |
$5,137.50
|
| Rate for Payer: TriWest Veterans Administration |
$4,521.00
|
| Rate for Payer: United Healthcare Commercial |
$5,959.50
|
| Rate for Payer: United Healthcare Medicare |
$4,521.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6,507.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,507.50
|
|
|
HC BIOPSY OF SKIN LESION
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
5101110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Aetna of WY Medicare |
$19.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.84
|
| Rate for Payer: Altius Commercial |
$27.84
|
| Rate for Payer: Beech Street Commercial |
$28.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: Entrust Commercial |
$27.55
|
| Rate for Payer: First Choice Health Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.82
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$15.98
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$28.42
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.82
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$16.82
|
| Rate for Payer: WINHealth Partners Commercial |
$28.42
|
| Rate for Payer: Wise Provider Network Commercial |
$27.55
|
|
|
HC BIOPSY OF SKIN LESION
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
7611110001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC BIOPSY OF SKIN LESION
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
7611110001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC BIOPSY OF SKIN LESION
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 11100
|
| Hospital Charge Code |
5101110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.84
|
| Rate for Payer: Altius Commercial |
$27.84
|
| Rate for Payer: Beech Street Commercial |
$28.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: Entrust Commercial |
$27.55
|
| Rate for Payer: First Choice Health Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$28.42
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$27.55
|
| Rate for Payer: Wise Provider Network Commercial |
$27.55
|
|
|
HC BIOPSY SOFT TISSUE NECK/CHEST
|
Facility
|
OP
|
$9,400.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
4022155001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$5,179.40 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,212.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,204.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,024.00
|
| Rate for Payer: Altius Commercial |
$9,024.00
|
| Rate for Payer: Beech Street Commercial |
$9,212.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,717.40
|
| Rate for Payer: Cash Price |
$6,580.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,118.00
|
| Rate for Payer: Cigna of WY Commercial |
$9,212.00
|
| Rate for Payer: Entrust Commercial |
$8,930.00
|
| Rate for Payer: First Choice Health Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,452.00
|
| Rate for Payer: HealthUtah PPO |
$9,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,118.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,179.40
|
| Rate for Payer: One Health Plan of WY PPO |
$9,212.00
|
| Rate for Payer: PacificSource Commercial |
$8,460.00
|
| Rate for Payer: PHCS PPO |
$9,212.00
|
| Rate for Payer: Three Rivers PPO |
$7,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,452.00
|
| Rate for Payer: United Healthcare Commercial |
$8,178.00
|
| Rate for Payer: United Healthcare Medicare |
$5,452.00
|
| Rate for Payer: WINHealth Partners Commercial |
$9,212.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,930.00
|
|
|
HC BIOPSY SOFT TISSUE NECK/CHEST
|
Facility
|
IP
|
$9,400.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
4022155001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$5,893.80 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,212.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,024.00
|
| Rate for Payer: Altius Commercial |
$9,024.00
|
| Rate for Payer: Beech Street Commercial |
$9,212.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,717.40
|
| Rate for Payer: Cash Price |
$6,580.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,118.00
|
| Rate for Payer: Cigna of WY Commercial |
$9,212.00
|
| Rate for Payer: Entrust Commercial |
$8,930.00
|
| Rate for Payer: First Choice Health Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,930.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,204.00
|
| Rate for Payer: HealthUtah PPO |
$9,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,118.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5,893.80
|
| Rate for Payer: One Health Plan of WY PPO |
$9,212.00
|
| Rate for Payer: PacificSource Commercial |
$8,460.00
|
| Rate for Payer: PHCS PPO |
$9,212.00
|
| Rate for Payer: Three Rivers PPO |
$7,050.00
|
| Rate for Payer: TriWest Veterans Administration |
$6,204.00
|
| Rate for Payer: United Healthcare Commercial |
$8,178.00
|
| Rate for Payer: United Healthcare Medicare |
$6,204.00
|
| Rate for Payer: WINHealth Partners Commercial |
$8,930.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,930.00
|
|
|
HC BIOPSY SOFT TISSUE NECK/CHEST
|
Facility
|
IP
|
$14,675.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
3502155001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$9,201.22 |
| Max. Negotiated Rate |
$14,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,381.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,088.00
|
| Rate for Payer: Altius Commercial |
$14,088.00
|
| Rate for Payer: Beech Street Commercial |
$14,381.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,048.18
|
| Rate for Payer: Cash Price |
$10,272.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,234.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,381.50
|
| Rate for Payer: Entrust Commercial |
$13,941.25
|
| Rate for Payer: First Choice Health Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,685.50
|
| Rate for Payer: HealthUtah PPO |
$14,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,234.75
|
| Rate for Payer: Multiplan Medicare/VA |
$9,201.22
|
| Rate for Payer: One Health Plan of WY PPO |
$14,381.50
|
| Rate for Payer: PacificSource Commercial |
$13,207.50
|
| Rate for Payer: PHCS PPO |
$14,381.50
|
| Rate for Payer: Three Rivers PPO |
$11,006.25
|
| Rate for Payer: TriWest Veterans Administration |
$9,685.50
|
| Rate for Payer: United Healthcare Commercial |
$12,767.25
|
| Rate for Payer: United Healthcare Medicare |
$9,685.50
|
| Rate for Payer: WINHealth Partners Commercial |
$13,941.25
|
| Rate for Payer: Wise Provider Network Commercial |
$13,941.25
|
|
|
HC BIOPSY SOFT TISSUE NECK/CHEST
|
Facility
|
OP
|
$14,675.00
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
3502155001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$8,085.92 |
| Max. Negotiated Rate |
$14,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,381.50
|
| Rate for Payer: Aetna of WY Medicare |
$9,685.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14,088.00
|
| Rate for Payer: Altius Commercial |
$14,088.00
|
| Rate for Payer: Beech Street Commercial |
$14,381.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12,048.18
|
| Rate for Payer: Cash Price |
$10,272.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,234.75
|
| Rate for Payer: Cigna of WY Commercial |
$14,381.50
|
| Rate for Payer: Entrust Commercial |
$13,941.25
|
| Rate for Payer: First Choice Health Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,941.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,511.50
|
| Rate for Payer: HealthUtah PPO |
$14,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,234.75
|
| Rate for Payer: Multiplan Medicare/VA |
$8,085.92
|
| Rate for Payer: One Health Plan of WY PPO |
$14,381.50
|
| Rate for Payer: PacificSource Commercial |
$13,207.50
|
| Rate for Payer: PHCS PPO |
$14,381.50
|
| Rate for Payer: Three Rivers PPO |
$11,006.25
|
| Rate for Payer: TriWest Veterans Administration |
$8,511.50
|
| Rate for Payer: United Healthcare Commercial |
$12,767.25
|
| Rate for Payer: United Healthcare Medicare |
$8,511.50
|
| Rate for Payer: WINHealth Partners Commercial |
$14,381.50
|
| Rate for Payer: Wise Provider Network Commercial |
$13,941.25
|
|
|
HC BIOPSY SOFT TISSUE SHOULDER DEEP
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 23066
|
| Hospital Charge Code |
5102306601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC BIOPSY SOFT TISSUE SHOULDER DEEP
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 23066
|
| Hospital Charge Code |
5102306601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
5102306501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$164.64
|
| Rate for Payer: Aetna of WY Medicare |
$110.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$161.28
|
| Rate for Payer: Altius Commercial |
$161.28
|
| Rate for Payer: Beech Street Commercial |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.93
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$162.96
|
| Rate for Payer: Cigna of WY Commercial |
$164.64
|
| Rate for Payer: Entrust Commercial |
$159.60
|
| Rate for Payer: First Choice Health Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.44
|
| Rate for Payer: HealthUtah PPO |
$168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$162.96
|
| Rate for Payer: Multiplan Medicare/VA |
$92.57
|
| Rate for Payer: One Health Plan of WY PPO |
$164.64
|
| Rate for Payer: PacificSource Commercial |
$151.20
|
| Rate for Payer: PHCS PPO |
$164.64
|
| Rate for Payer: Three Rivers PPO |
$126.00
|
| Rate for Payer: TriWest Veterans Administration |
$97.44
|
| Rate for Payer: United Healthcare Commercial |
$146.16
|
| Rate for Payer: United Healthcare Medicare |
$97.44
|
| Rate for Payer: WINHealth Partners Commercial |
$164.64
|
| Rate for Payer: Wise Provider Network Commercial |
$159.60
|
|
|
HC BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS 23065
|
| Hospital Charge Code |
5102306501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$164.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$161.28
|
| Rate for Payer: Altius Commercial |
$161.28
|
| Rate for Payer: Beech Street Commercial |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.93
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$162.96
|
| Rate for Payer: Cigna of WY Commercial |
$164.64
|
| Rate for Payer: Entrust Commercial |
$159.60
|
| Rate for Payer: First Choice Health Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$159.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.88
|
| Rate for Payer: HealthUtah PPO |
$168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$162.96
|
| Rate for Payer: Multiplan Medicare/VA |
$105.34
|
| Rate for Payer: One Health Plan of WY PPO |
$164.64
|
| Rate for Payer: PacificSource Commercial |
$151.20
|
| Rate for Payer: PHCS PPO |
$164.64
|
| Rate for Payer: Three Rivers PPO |
$126.00
|
| Rate for Payer: TriWest Veterans Administration |
$110.88
|
| Rate for Payer: United Healthcare Commercial |
$146.16
|
| Rate for Payer: United Healthcare Medicare |
$110.88
|
| Rate for Payer: WINHealth Partners Commercial |
$159.60
|
| Rate for Payer: Wise Provider Network Commercial |
$159.60
|
|
|
HC BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
5104110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.16 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$252.84
|
| Rate for Payer: Aetna of WY Medicare |
$170.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$247.68
|
| Rate for Payer: Altius Commercial |
$247.68
|
| Rate for Payer: Beech Street Commercial |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$250.26
|
| Rate for Payer: Cigna of WY Commercial |
$252.84
|
| Rate for Payer: Entrust Commercial |
$245.10
|
| Rate for Payer: First Choice Health Commercial |
$245.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$245.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.64
|
| Rate for Payer: HealthUtah PPO |
$258.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$250.26
|
| Rate for Payer: Multiplan Medicare/VA |
$142.16
|
| Rate for Payer: One Health Plan of WY PPO |
$252.84
|
| Rate for Payer: PacificSource Commercial |
$232.20
|
| Rate for Payer: PHCS PPO |
$252.84
|
| Rate for Payer: Three Rivers PPO |
$193.50
|
| Rate for Payer: TriWest Veterans Administration |
$149.64
|
| Rate for Payer: United Healthcare Commercial |
$224.46
|
| Rate for Payer: United Healthcare Medicare |
$149.64
|
| Rate for Payer: WINHealth Partners Commercial |
$252.84
|
| Rate for Payer: Wise Provider Network Commercial |
$245.10
|
|
|
HC BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
5104110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$252.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$247.68
|
| Rate for Payer: Altius Commercial |
$247.68
|
| Rate for Payer: Beech Street Commercial |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$211.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$250.26
|
| Rate for Payer: Cigna of WY Commercial |
$252.84
|
| Rate for Payer: Entrust Commercial |
$245.10
|
| Rate for Payer: First Choice Health Commercial |
$245.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$245.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.28
|
| Rate for Payer: HealthUtah PPO |
$258.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$250.26
|
| Rate for Payer: Multiplan Medicare/VA |
$161.77
|
| Rate for Payer: One Health Plan of WY PPO |
$252.84
|
| Rate for Payer: PacificSource Commercial |
$232.20
|
| Rate for Payer: PHCS PPO |
$252.84
|
| Rate for Payer: Three Rivers PPO |
$193.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.28
|
| Rate for Payer: United Healthcare Commercial |
$224.46
|
| Rate for Payer: United Healthcare Medicare |
$170.28
|
| Rate for Payer: WINHealth Partners Commercial |
$245.10
|
| Rate for Payer: Wise Provider Network Commercial |
$245.10
|
|
