|
HC DOPPLER FETAL UMBILICAL ARTERY
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
4027682002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC DOPPLER FETAL UMBILICAL ARTERY
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 76820 26
|
| Hospital Charge Code |
9727682001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.14
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$73.28
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.14
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$77.14
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
HC DOPPLER FETAL UMBILICAL ARTERY
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
4027682002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC DPYD GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
3108123201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$689.70 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$726.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$689.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC DPYD GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
3108123201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Aetna of WY Medicare |
$726.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$606.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,078.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$141.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$138.24
|
| Rate for Payer: Altius Commercial |
$138.24
|
| Rate for Payer: Beech Street Commercial |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.22
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.68
|
| Rate for Payer: Cigna of WY Commercial |
$141.12
|
| Rate for Payer: Entrust Commercial |
$136.80
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.04
|
| Rate for Payer: HealthUtah PPO |
$144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.68
|
| Rate for Payer: Multiplan Medicare/VA |
$90.29
|
| Rate for Payer: One Health Plan of WY PPO |
$141.12
|
| Rate for Payer: PacificSource Commercial |
$129.60
|
| Rate for Payer: PHCS PPO |
$141.12
|
| Rate for Payer: Three Rivers PPO |
$108.00
|
| Rate for Payer: TriWest Veterans Administration |
$95.04
|
| Rate for Payer: United Healthcare Commercial |
$125.28
|
| Rate for Payer: United Healthcare Medicare |
$95.04
|
| Rate for Payer: WINHealth Partners Commercial |
$136.80
|
| Rate for Payer: Wise Provider Network Commercial |
$136.80
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.34 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$141.12
|
| Rate for Payer: Aetna of WY Medicare |
$95.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$138.24
|
| Rate for Payer: Altius Commercial |
$138.24
|
| Rate for Payer: Beech Street Commercial |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$118.22
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$139.68
|
| Rate for Payer: Cigna of WY Commercial |
$141.12
|
| Rate for Payer: Entrust Commercial |
$136.80
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.52
|
| Rate for Payer: HealthUtah PPO |
$144.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$139.68
|
| Rate for Payer: Multiplan Medicare/VA |
$79.34
|
| Rate for Payer: One Health Plan of WY PPO |
$141.12
|
| Rate for Payer: PacificSource Commercial |
$129.60
|
| Rate for Payer: PHCS PPO |
$141.12
|
| Rate for Payer: Three Rivers PPO |
$108.00
|
| Rate for Payer: TriWest Veterans Administration |
$83.52
|
| Rate for Payer: United Healthcare Commercial |
$125.28
|
| Rate for Payer: United Healthcare Medicare |
$83.52
|
| Rate for Payer: WINHealth Partners Commercial |
$141.12
|
| Rate for Payer: Wise Provider Network Commercial |
$136.80
|
|
|
HC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
5106900501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.26 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$106.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.96
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$89.26
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.96
|
| Rate for Payer: United Healthcare Commercial |
$140.94
|
| Rate for Payer: United Healthcare Medicare |
$93.96
|
| Rate for Payer: WINHealth Partners Commercial |
$158.76
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
5106900501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$155.52
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.92
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$101.57
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.92
|
| Rate for Payer: United Healthcare Commercial |
$140.94
|
| Rate for Payer: United Healthcare Medicare |
$106.92
|
| Rate for Payer: WINHealth Partners Commercial |
$153.90
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
5106900001
|
|
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 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
5106900001
|
|
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 DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
5102601001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.11 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.36
|
| Rate for Payer: Altius Commercial |
$231.36
|
| Rate for Payer: Beech Street Commercial |
$236.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.86
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: Entrust Commercial |
$228.95
|
| Rate for Payer: First Choice Health Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.06
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$151.11
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$236.18
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$159.06
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$159.06
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
| Rate for Payer: Wise Provider Network Commercial |
$228.95
|
|
|
HC DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
5102601001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Aetna of WY Medicare |
$159.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.36
|
| Rate for Payer: Altius Commercial |
$231.36
|
| Rate for Payer: Beech Street Commercial |
$236.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.86
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: Entrust Commercial |
$228.95
|
| Rate for Payer: First Choice Health Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.78
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$132.79
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$236.18
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$139.78
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$139.78
|
| Rate for Payer: WINHealth Partners Commercial |
$236.18
|
| Rate for Payer: Wise Provider Network Commercial |
$228.95
|
|
|
HC DRAINAGE OF FINGER ABSCESS COMPLICATED
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
5102601101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$219.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.14
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.48
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.14
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$193.14
|
| Rate for Payer: WINHealth Partners Commercial |
$326.34
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC DRAINAGE OF FINGER ABSCESS COMPLICATED
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
5102601101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$208.79 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.78
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$208.79
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.78
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
7614180001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
7614180001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7611014001
|
|
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 DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
7611014001
|
|
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 DRAINAGE OF TONSIL ABSCESS
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
5104270001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$405.54 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.28
|
| Rate for Payer: Aetna of WY Medicare |
$485.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$706.56
|
| Rate for Payer: Altius Commercial |
$706.56
|
| Rate for Payer: Beech Street Commercial |
$721.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$604.26
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.92
|
| Rate for Payer: Cigna of WY Commercial |
$721.28
|
| Rate for Payer: Entrust Commercial |
$699.20
|
| Rate for Payer: First Choice Health Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.88
|
| Rate for Payer: HealthUtah PPO |
$736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.92
|
| Rate for Payer: Multiplan Medicare/VA |
$405.54
|
| Rate for Payer: One Health Plan of WY PPO |
$721.28
|
| Rate for Payer: PacificSource Commercial |
$662.40
|
| Rate for Payer: PHCS PPO |
$721.28
|
| Rate for Payer: Three Rivers PPO |
$552.00
|
| Rate for Payer: TriWest Veterans Administration |
$426.88
|
| Rate for Payer: United Healthcare Commercial |
$640.32
|
| Rate for Payer: United Healthcare Medicare |
$426.88
|
| Rate for Payer: WINHealth Partners Commercial |
$721.28
|
| Rate for Payer: Wise Provider Network Commercial |
$699.20
|
|
|
HC DRAINAGE OF TONSIL ABSCESS
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
5104270001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$461.47 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$721.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$706.56
|
| Rate for Payer: Altius Commercial |
$706.56
|
| Rate for Payer: Beech Street Commercial |
$721.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$604.26
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.92
|
| Rate for Payer: Cigna of WY Commercial |
$721.28
|
| Rate for Payer: Entrust Commercial |
$699.20
|
| Rate for Payer: First Choice Health Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$699.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$485.76
|
| Rate for Payer: HealthUtah PPO |
$736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.92
|
| Rate for Payer: Multiplan Medicare/VA |
$461.47
|
| Rate for Payer: One Health Plan of WY PPO |
$721.28
|
| Rate for Payer: PacificSource Commercial |
$662.40
|
| Rate for Payer: PHCS PPO |
$721.28
|
| Rate for Payer: Three Rivers PPO |
$552.00
|
| Rate for Payer: TriWest Veterans Administration |
$485.76
|
| Rate for Payer: United Healthcare Commercial |
$640.32
|
| Rate for Payer: United Healthcare Medicare |
$485.76
|
| Rate for Payer: WINHealth Partners Commercial |
$699.20
|
| Rate for Payer: Wise Provider Network Commercial |
$699.20
|
|
|
HC DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
5102602001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 26020
|
| Hospital Charge Code |
5102602001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC DRAIN BLOOD FROM UNDER NAIL
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
7611174001
|
|
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 DRAIN BLOOD FROM UNDER NAIL
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
7611174001
|
|
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
|
|
