|
HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
4903659301
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$363.66 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$646.80
|
| Rate for Payer: Aetna of WY Medicare |
$435.60
|
| 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 |
$382.80
|
| Rate for Payer: HealthUtah PPO |
$660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$640.20
|
| Rate for Payer: Multiplan Medicare/VA |
$363.66
|
| 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 |
$382.80
|
| Rate for Payer: United Healthcare Commercial |
$574.20
|
| Rate for Payer: United Healthcare Medicare |
$382.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.80
|
| Rate for Payer: Wise Provider Network Commercial |
$627.00
|
|
|
HC DEHYDROEPIANDROSTERONE - DHEA
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
3018262601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.80
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$206.91
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$217.80
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC DEHYDROEPIANDROSTERONE - DHEA
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 82626
|
| Hospital Charge Code |
3018262601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$217.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.40
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
3018262701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
3018262701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC DENTAL SURGERY PROCEDURE
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
7614189901
|
|
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 DENTAL SURGERY PROCEDURE
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
7614189901
|
|
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 DEOXYCORTISOL - 11-DEOXYCORTISOL
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
3018263401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC DEOXYCORTISOL - 11-DEOXYCORTISOL
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
3018263401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.02
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
3028621501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
3028621501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC DESFLURANE SUPRANE 15 MN
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
3700000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC DESFLURANE SUPRANE 15 MN
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
3700000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC DESTRUC BENIGN/PREMAL 2 TO 14 LESIONS
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
5101700301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.30
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$3.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC DESTRUC BENIGN/PREMAL 2 TO 14 LESIONS
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
5101700301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.90
|
| Rate for Payer: Aetna of WY Medicare |
$3.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.80
|
| Rate for Payer: Altius Commercial |
$4.80
|
| Rate for Payer: Beech Street Commercial |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.85
|
| Rate for Payer: Cigna of WY Commercial |
$4.90
|
| Rate for Payer: Entrust Commercial |
$4.75
|
| Rate for Payer: First Choice Health Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.90
|
| Rate for Payer: HealthUtah PPO |
$5.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.85
|
| Rate for Payer: Multiplan Medicare/VA |
$2.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4.90
|
| Rate for Payer: PacificSource Commercial |
$4.50
|
| Rate for Payer: PHCS PPO |
$4.90
|
| Rate for Payer: Three Rivers PPO |
$3.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.90
|
| Rate for Payer: United Healthcare Commercial |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$2.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4.90
|
| Rate for Payer: Wise Provider Network Commercial |
$4.75
|
|
|
HC DESTRUC BENIGN/PREMAL,FIRST LESION
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
5101700001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.32
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.75
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$31.32
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC DESTRUC BENIGN/PREMAL,FIRST LESION
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
5101700001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.64
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$35.64
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC DESTRUCT BENIGN/PREMAL,15+ LESIONS
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
5101700401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.12
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.64
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.26
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$53.45
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.26
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$56.26
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC DESTRUCT BENIGN/PREMAL,15+ LESIONS
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
5101700401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.12
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.64
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.02
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$60.82
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.02
|
| Rate for Payer: United Healthcare Commercial |
$84.39
|
| Rate for Payer: United Healthcare Medicare |
$64.02
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
5101711101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Aetna of WY Medicare |
$61.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.94
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$51.24
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.94
|
| Rate for Payer: United Healthcare Commercial |
$80.91
|
| Rate for Payer: United Healthcare Medicare |
$53.94
|
| Rate for Payer: WINHealth Partners Commercial |
$91.14
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC DESTRUCTION BENIGN LESIONS 15/>
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
5101711101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.28
|
| Rate for Payer: Altius Commercial |
$89.28
|
| Rate for Payer: Beech Street Commercial |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: Entrust Commercial |
$88.35
|
| Rate for Payer: First Choice Health Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.38
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: Multiplan Medicare/VA |
$58.31
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$91.14
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$80.91
|
| Rate for Payer: United Healthcare Medicare |
$61.38
|
| Rate for Payer: WINHealth Partners Commercial |
$88.35
|
| Rate for Payer: Wise Provider Network Commercial |
$88.35
|
|
|
HC DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
5101711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC DESTRUCTION BENIGN LESIONS UP TO 14
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
5101711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC DESTRUCTION LESIONS VULVA EXTENSIVE
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
5105651501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.27 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$314.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$308.16
|
| Rate for Payer: Altius Commercial |
$308.16
|
| Rate for Payer: Beech Street Commercial |
$314.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.54
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$311.37
|
| Rate for Payer: Cigna of WY Commercial |
$314.58
|
| Rate for Payer: Entrust Commercial |
$304.95
|
| Rate for Payer: First Choice Health Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.86
|
| Rate for Payer: HealthUtah PPO |
$321.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$311.37
|
| Rate for Payer: Multiplan Medicare/VA |
$201.27
|
| Rate for Payer: One Health Plan of WY PPO |
$314.58
|
| Rate for Payer: PacificSource Commercial |
$288.90
|
| Rate for Payer: PHCS PPO |
$314.58
|
| Rate for Payer: Three Rivers PPO |
$240.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.86
|
| Rate for Payer: United Healthcare Commercial |
$279.27
|
| Rate for Payer: United Healthcare Medicare |
$211.86
|
| Rate for Payer: WINHealth Partners Commercial |
$304.95
|
| Rate for Payer: Wise Provider Network Commercial |
$304.95
|
|
|
HC DESTRUCTION LESIONS VULVA EXTENSIVE
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
5105651501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.87 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$314.58
|
| Rate for Payer: Aetna of WY Medicare |
$211.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$308.16
|
| Rate for Payer: Altius Commercial |
$308.16
|
| Rate for Payer: Beech Street Commercial |
$314.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.54
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$311.37
|
| Rate for Payer: Cigna of WY Commercial |
$314.58
|
| Rate for Payer: Entrust Commercial |
$304.95
|
| Rate for Payer: First Choice Health Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.18
|
| Rate for Payer: HealthUtah PPO |
$321.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$311.37
|
| Rate for Payer: Multiplan Medicare/VA |
$176.87
|
| Rate for Payer: One Health Plan of WY PPO |
$314.58
|
| Rate for Payer: PacificSource Commercial |
$288.90
|
| Rate for Payer: PHCS PPO |
$314.58
|
| Rate for Payer: Three Rivers PPO |
$240.75
|
| Rate for Payer: TriWest Veterans Administration |
$186.18
|
| Rate for Payer: United Healthcare Commercial |
$279.27
|
| Rate for Payer: United Healthcare Medicare |
$186.18
|
| Rate for Payer: WINHealth Partners Commercial |
$314.58
|
| Rate for Payer: Wise Provider Network Commercial |
$304.95
|
|
