|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
9409759701
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
5109759701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.36
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.56
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$41.38
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$43.56
|
| Rate for Payer: WINHealth Partners Commercial |
$62.70
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9839759801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$103.59 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Aetna of WY Medicare |
$124.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$180.48
|
| Rate for Payer: Altius Commercial |
$180.48
|
| Rate for Payer: Beech Street Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.35
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: Entrust Commercial |
$178.60
|
| Rate for Payer: First Choice Health Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.04
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: Multiplan Medicare/VA |
$103.59
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$184.24
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.04
|
| Rate for Payer: United Healthcare Commercial |
$163.56
|
| Rate for Payer: United Healthcare Medicare |
$109.04
|
| Rate for Payer: WINHealth Partners Commercial |
$184.24
|
| Rate for Payer: Wise Provider Network Commercial |
$178.60
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
7619759801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.30
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$285.28
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.30
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
5109759801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
5109759801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.04
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.94
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.04
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$22.04
|
| Rate for Payer: WINHealth Partners Commercial |
$37.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
7619759801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9409759801
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.70
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$153.62
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$161.70
|
| Rate for Payer: WINHealth Partners Commercial |
$232.75
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9409759801
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.20
|
| Rate for Payer: Altius Commercial |
$235.20
|
| Rate for Payer: Beech Street Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.14
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: Entrust Commercial |
$232.75
|
| Rate for Payer: First Choice Health Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.10
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$135.00
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$240.10
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.10
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$142.10
|
| Rate for Payer: WINHealth Partners Commercial |
$240.10
|
| Rate for Payer: Wise Provider Network Commercial |
$232.75
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
9839759801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$180.48
|
| Rate for Payer: Altius Commercial |
$180.48
|
| Rate for Payer: Beech Street Commercial |
$184.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.35
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: Entrust Commercial |
$178.60
|
| Rate for Payer: First Choice Health Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.08
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: Multiplan Medicare/VA |
$117.88
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$184.24
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: TriWest Veterans Administration |
$124.08
|
| Rate for Payer: United Healthcare Commercial |
$163.56
|
| Rate for Payer: United Healthcare Medicare |
$124.08
|
| Rate for Payer: WINHealth Partners Commercial |
$178.60
|
| Rate for Payer: Wise Provider Network Commercial |
$178.60
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
7611104201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
5101104201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.40
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$56.43
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$59.40
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
7611104201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
5101104201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$59.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.40
|
| Rate for Payer: Altius Commercial |
$86.40
|
| Rate for Payer: Beech Street Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.89
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: Entrust Commercial |
$85.50
|
| Rate for Payer: First Choice Health Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.20
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$49.59
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$88.20
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: United Healthcare Medicare |
$52.20
|
| Rate for Payer: WINHealth Partners Commercial |
$88.20
|
| Rate for Payer: Wise Provider Network Commercial |
$85.50
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.52
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$421.34
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$443.52
|
| Rate for Payer: WINHealth Partners Commercial |
$638.40
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$443.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.76
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$370.27
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$389.76
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$389.76
|
| Rate for Payer: WINHealth Partners Commercial |
$658.56
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
5101104501
|
|
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 DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
5101104501
|
|
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 DECALCIFY TISSUE - LAB SURG PATH,LEVEL III
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
3128831101
|
|
Hospital Revenue Code
|
312
|
| 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 DECALCIFY TISSUE - LAB SURG PATH,LEVEL III
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
3128831101
|
|
Hospital Revenue Code
|
312
|
| 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 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
2603659301
|
|
Hospital Revenue Code
|
260
|
| 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 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
4903659301
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$413.82 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$633.60
|
| Rate for Payer: Altius Commercial |
$633.60
|
| Rate for Payer: Beech Street Commercial |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.86
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$640.20
|
| Rate for Payer: Cigna of WY Commercial |
$646.80
|
| Rate for Payer: Entrust Commercial |
$627.00
|
| Rate for Payer: First Choice Health Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.60
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$413.82
|
| Rate for Payer: One Health Plan of WY PPO |
$646.80
|
| Rate for Payer: PacificSource Commercial |
$594.00
|
| Rate for Payer: PHCS PPO |
$646.80
|
| Rate for Payer: Three Rivers PPO |
$495.00
|
| Rate for Payer: TriWest Veterans Administration |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$435.60
|
| Rate for Payer: WINHealth Partners Commercial |
$627.00
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
2603659301
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
