|
HC DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
5101728001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$57.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.46
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.94
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
| Rate for Payer: WINHealth Partners Commercial |
$85.26
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
5101728001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
5101727001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.36
|
| Rate for Payer: Altius Commercial |
$135.36
|
| Rate for Payer: Beech Street Commercial |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.77
|
| Rate for Payer: Cigna of WY Commercial |
$138.18
|
| Rate for Payer: Entrust Commercial |
$133.95
|
| Rate for Payer: First Choice Health Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.06
|
| Rate for Payer: HealthUtah PPO |
$141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.77
|
| Rate for Payer: Multiplan Medicare/VA |
$88.41
|
| Rate for Payer: One Health Plan of WY PPO |
$138.18
|
| Rate for Payer: PacificSource Commercial |
$126.90
|
| Rate for Payer: PHCS PPO |
$138.18
|
| Rate for Payer: Three Rivers PPO |
$105.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$122.67
|
| Rate for Payer: United Healthcare Medicare |
$93.06
|
| Rate for Payer: WINHealth Partners Commercial |
$133.95
|
| Rate for Payer: Wise Provider Network Commercial |
$133.95
|
|
|
HC DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
5101727001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.69 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.18
|
| Rate for Payer: Aetna of WY Medicare |
$93.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.36
|
| Rate for Payer: Altius Commercial |
$135.36
|
| Rate for Payer: Beech Street Commercial |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.77
|
| Rate for Payer: Cigna of WY Commercial |
$138.18
|
| Rate for Payer: Entrust Commercial |
$133.95
|
| Rate for Payer: First Choice Health Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.78
|
| Rate for Payer: HealthUtah PPO |
$141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.77
|
| Rate for Payer: Multiplan Medicare/VA |
$77.69
|
| Rate for Payer: One Health Plan of WY PPO |
$138.18
|
| Rate for Payer: PacificSource Commercial |
$126.90
|
| Rate for Payer: PHCS PPO |
$138.18
|
| Rate for Payer: Three Rivers PPO |
$105.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.78
|
| Rate for Payer: United Healthcare Commercial |
$122.67
|
| Rate for Payer: United Healthcare Medicare |
$81.78
|
| Rate for Payer: WINHealth Partners Commercial |
$138.18
|
| Rate for Payer: Wise Provider Network Commercial |
$133.95
|
|
|
HC DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 17260
|
| Hospital Charge Code |
5101726001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 17260
|
| Hospital Charge Code |
5101726001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 17261
|
| Hospital Charge Code |
5101726101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 17261
|
| Hospital Charge Code |
5101726101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$57.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.46
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.94
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
| Rate for Payer: WINHealth Partners Commercial |
$85.26
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
5101726201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$73.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$107.52
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.95
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.96
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$61.71
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$64.96
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$64.96
|
| Rate for Payer: WINHealth Partners Commercial |
$109.76
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
5101726201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.22 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$107.52
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.95
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.92
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$70.22
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$73.92
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$73.92
|
| Rate for Payer: WINHealth Partners Commercial |
$106.40
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 17263
|
| Hospital Charge Code |
5101726301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.75 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.84
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$77.75
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.84
|
| Rate for Payer: United Healthcare Commercial |
$107.88
|
| Rate for Payer: United Healthcare Medicare |
$81.84
|
| Rate for Payer: WINHealth Partners Commercial |
$117.80
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 17263
|
| Hospital Charge Code |
5101726301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$81.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.92
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$68.32
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$71.92
|
| Rate for Payer: United Healthcare Commercial |
$107.88
|
| Rate for Payer: United Healthcare Medicare |
$71.92
|
| Rate for Payer: WINHealth Partners Commercial |
$121.52
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 17264
|
| Hospital Charge Code |
5101726401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.12
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$82.76
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.12
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$87.12
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 17264
|
| Hospital Charge Code |
5101726401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$87.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.56
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$72.73
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$76.56
|
| Rate for Payer: WINHealth Partners Commercial |
$129.36
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 17266
|
| Hospital Charge Code |
5101726601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.48
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$85.96
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$90.48
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$90.48
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 17266
|
| Hospital Charge Code |
5101726601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.96
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.96
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$102.96
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
5105706101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$358.02 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$559.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$548.16
|
| Rate for Payer: Altius Commercial |
$548.16
|
| Rate for Payer: Beech Street Commercial |
$559.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$468.79
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.87
|
| Rate for Payer: Cigna of WY Commercial |
$559.58
|
| Rate for Payer: Entrust Commercial |
$542.45
|
| Rate for Payer: First Choice Health Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.86
|
| Rate for Payer: HealthUtah PPO |
$571.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.87
|
| Rate for Payer: Multiplan Medicare/VA |
$358.02
|
| Rate for Payer: One Health Plan of WY PPO |
$559.58
|
| Rate for Payer: PacificSource Commercial |
$513.90
|
| Rate for Payer: PHCS PPO |
$559.58
|
| Rate for Payer: Three Rivers PPO |
$428.25
|
| Rate for Payer: TriWest Veterans Administration |
$376.86
|
| Rate for Payer: United Healthcare Commercial |
$496.77
|
| Rate for Payer: United Healthcare Medicare |
$376.86
|
| Rate for Payer: WINHealth Partners Commercial |
$542.45
|
| Rate for Payer: Wise Provider Network Commercial |
$542.45
|
|
|
HC DESTRUCTION VAGINAL LESIONS SIMPLE
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
5105706101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.62 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$559.58
|
| Rate for Payer: Aetna of WY Medicare |
$376.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$548.16
|
| Rate for Payer: Altius Commercial |
$548.16
|
| Rate for Payer: Beech Street Commercial |
$559.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$468.79
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.87
|
| Rate for Payer: Cigna of WY Commercial |
$559.58
|
| Rate for Payer: Entrust Commercial |
$542.45
|
| Rate for Payer: First Choice Health Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.18
|
| Rate for Payer: HealthUtah PPO |
$571.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.87
|
| Rate for Payer: Multiplan Medicare/VA |
$314.62
|
| Rate for Payer: One Health Plan of WY PPO |
$559.58
|
| Rate for Payer: PacificSource Commercial |
$513.90
|
| Rate for Payer: PHCS PPO |
$559.58
|
| Rate for Payer: Three Rivers PPO |
$428.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.18
|
| Rate for Payer: United Healthcare Commercial |
$496.77
|
| Rate for Payer: United Healthcare Medicare |
$331.18
|
| Rate for Payer: WINHealth Partners Commercial |
$559.58
|
| Rate for Payer: Wise Provider Network Commercial |
$542.45
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,C DIFF TOXIN - CLOSTRIDIUM TOXIN A SCREEN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87803
|
| Hospital Charge Code |
3068780301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,C DIFF TOXIN - CLOSTRIDIUM TOXIN A SCREEN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87803
|
| Hospital Charge Code |
3068780301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$63.80
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS RESPIRAORY SYNCYTIAL VIRUS (RSV)
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
3068780701
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT,IMMUN,DIR OBS RESPIRAORY SYNCYTIAL VIRUS (RSV)
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
3068780701
|
|
Hospital Revenue Code
|
306
|
| 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 DETECT AGENT,IMMUN,DIR OBS,STREP B - STREP B ANTIGEN
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 87802
|
| Hospital Charge Code |
3068780201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
