HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE
|
Facility
|
OP
|
$331.00
|
|
Service Code
|
HCPCS 69000
|
Hospital Charge Code |
7616900001
|
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 EXT EAR ABSC/BLOOD,SIMPLE
|
Facility
|
IP
|
$331.00
|
|
Service Code
|
HCPCS 69000
|
Hospital Charge Code |
7616900001
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$207.54 |
Max. Negotiated Rate |
$331.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
Rate for Payer: Altius Commercial |
$317.76
|
Rate for Payer: Beech Street Commercial |
$324.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
Rate for Payer: Cash Price |
$231.70
|
Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
Rate for Payer: Cigna of WY Commercial |
$324.38
|
Rate for Payer: Entrust Commercial |
$314.45
|
Rate for Payer: First Choice Health Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
Rate for Payer: HealthUtah PPO |
$331.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
Rate for Payer: Multiplan Medicare/VA |
$207.54
|
Rate for Payer: One Health Plan of WY PPO |
$324.38
|
Rate for Payer: PacificSource Commercial |
$297.90
|
Rate for Payer: PHCS PPO |
$324.38
|
Rate for Payer: Three Rivers PPO |
$248.25
|
Rate for Payer: TriWest Veterans Administration |
$218.46
|
Rate for Payer: United Healthcare Commercial |
$287.97
|
Rate for Payer: United Healthcare Medicare |
$218.46
|
Rate for Payer: WINHealth Partners Commercial |
$314.45
|
Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
HC DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 26011
|
Hospital Charge Code |
7612601101
|
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 DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 26011
|
Hospital Charge Code |
7612601101
|
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 DRAIN FINGER ABSCESS,SIMPLE
|
Facility
|
OP
|
$331.00
|
|
Service Code
|
HCPCS 26010
|
Hospital Charge Code |
7612601001
|
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 FINGER ABSCESS,SIMPLE
|
Facility
|
IP
|
$331.00
|
|
Service Code
|
HCPCS 26010
|
Hospital Charge Code |
7612601001
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$207.54 |
Max. Negotiated Rate |
$331.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
Rate for Payer: Altius Commercial |
$317.76
|
Rate for Payer: Beech Street Commercial |
$324.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
Rate for Payer: Cash Price |
$231.70
|
Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
Rate for Payer: Cigna of WY Commercial |
$324.38
|
Rate for Payer: Entrust Commercial |
$314.45
|
Rate for Payer: First Choice Health Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
Rate for Payer: HealthUtah PPO |
$331.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
Rate for Payer: Multiplan Medicare/VA |
$207.54
|
Rate for Payer: One Health Plan of WY PPO |
$324.38
|
Rate for Payer: PacificSource Commercial |
$297.90
|
Rate for Payer: PHCS PPO |
$324.38
|
Rate for Payer: Three Rivers PPO |
$248.25
|
Rate for Payer: TriWest Veterans Administration |
$218.46
|
Rate for Payer: United Healthcare Commercial |
$287.97
|
Rate for Payer: United Healthcare Medicare |
$218.46
|
Rate for Payer: WINHealth Partners Commercial |
$314.45
|
Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
HC DRAIN PILONIDAL CYST SIMPL
|
Facility
|
OP
|
$331.00
|
|
Service Code
|
HCPCS 10080
|
Hospital Charge Code |
7611008001
|
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 PILONIDAL CYST SIMPL
|
Facility
|
IP
|
$331.00
|
|
Service Code
|
HCPCS 10080
|
Hospital Charge Code |
7611008001
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$207.54 |
Max. Negotiated Rate |
$331.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
Rate for Payer: Altius Commercial |
$317.76
|
Rate for Payer: Beech Street Commercial |
$324.38
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
Rate for Payer: Cash Price |
$231.70
|
Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
Rate for Payer: Cigna of WY Commercial |
$324.38
|
Rate for Payer: Entrust Commercial |
$314.45
|
Rate for Payer: First Choice Health Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
Rate for Payer: HealthUtah PPO |
$331.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
Rate for Payer: Multiplan Medicare/VA |
$207.54
|
Rate for Payer: One Health Plan of WY PPO |
$324.38
|
Rate for Payer: PacificSource Commercial |
$297.90
|
Rate for Payer: PHCS PPO |
$324.38
|
Rate for Payer: Three Rivers PPO |
$248.25
|
Rate for Payer: TriWest Veterans Administration |
$218.46
|
Rate for Payer: United Healthcare Commercial |
$287.97
|
Rate for Payer: United Healthcare Medicare |
$218.46
|
Rate for Payer: WINHealth Partners Commercial |
$314.45
|
Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
HC DRAIN SKIN ABSCESS COMPLIC
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 10061
|
Hospital Charge Code |
7611006101
|
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 DRAIN SKIN ABSCESS COMPLIC
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 10061
|
Hospital Charge Code |
7611006101
|
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 DRESS/DEBRID LARGE BURN NO ANES
|
Facility
|
OP
|
$133.00
|
|
Service Code
|
HCPCS 16030
|
Hospital Charge Code |
5101603001
|
Hospital Revenue Code
|
510
|
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 DRESS/DEBRID LARGE BURN NO ANES
|
Facility
|
IP
|
$133.00
|
|
Service Code
|
HCPCS 16030
|
Hospital Charge Code |
5101603001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$83.39 |
Max. Negotiated Rate |
$133.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
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 |
$87.78
|
Rate for Payer: HealthUtah PPO |
$133.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
Rate for Payer: Multiplan Medicare/VA |
$83.39
|
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 |
$87.78
|
Rate for Payer: United Healthcare Commercial |
$115.71
|
Rate for Payer: United Healthcare Medicare |
$87.78
|
Rate for Payer: WINHealth Partners Commercial |
$126.35
|
Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
HC DRESS/DEBRID MED BURN NO ANES
|
Facility
|
IP
|
$111.00
|
|
Service Code
|
HCPCS 16025
|
Hospital Charge Code |
5101602501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$69.60 |
Max. Negotiated Rate |
$111.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
Rate for Payer: Altius Commercial |
$106.56
|
Rate for Payer: Beech Street Commercial |
$108.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
Rate for Payer: Cash Price |
$77.70
|
Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
Rate for Payer: Cigna of WY Commercial |
$108.78
|
Rate for Payer: Entrust Commercial |
$105.45
|
Rate for Payer: First Choice Health Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.26
|
Rate for Payer: HealthUtah PPO |
$111.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
Rate for Payer: Multiplan Medicare/VA |
$69.60
|
Rate for Payer: One Health Plan of WY PPO |
$108.78
|
Rate for Payer: PacificSource Commercial |
$99.90
|
Rate for Payer: PHCS PPO |
$108.78
|
Rate for Payer: Three Rivers PPO |
$83.25
|
Rate for Payer: TriWest Veterans Administration |
$73.26
|
Rate for Payer: United Healthcare Commercial |
$96.57
|
Rate for Payer: United Healthcare Medicare |
$73.26
|
Rate for Payer: WINHealth Partners Commercial |
$105.45
|
Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
HC DRESS/DEBRID MED BURN NO ANES
|
Facility
|
OP
|
$111.00
|
|
Service Code
|
HCPCS 16025
|
Hospital Charge Code |
5101602501
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$61.16 |
Max. Negotiated Rate |
$111.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
Rate for Payer: Aetna of WY Medicare |
$73.26
|
Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
Rate for Payer: Altius Commercial |
$106.56
|
Rate for Payer: Beech Street Commercial |
$108.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
Rate for Payer: Cash Price |
$77.70
|
Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
Rate for Payer: Cigna of WY Commercial |
$108.78
|
Rate for Payer: Entrust Commercial |
$105.45
|
Rate for Payer: First Choice Health Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.38
|
Rate for Payer: HealthUtah PPO |
$111.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
Rate for Payer: Multiplan Medicare/VA |
$61.16
|
Rate for Payer: One Health Plan of WY PPO |
$108.78
|
Rate for Payer: PacificSource Commercial |
$99.90
|
Rate for Payer: PHCS PPO |
$108.78
|
Rate for Payer: Three Rivers PPO |
$83.25
|
Rate for Payer: TriWest Veterans Administration |
$64.38
|
Rate for Payer: United Healthcare Commercial |
$96.57
|
Rate for Payer: United Healthcare Medicare |
$64.38
|
Rate for Payer: WINHealth Partners Commercial |
$108.78
|
Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 16025
|
Hospital Charge Code |
7611602501
|
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 DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 16025
|
Hospital Charge Code |
7611602501
|
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 DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
OP
|
$54.00
|
|
Service Code
|
HCPCS 16020
|
Hospital Charge Code |
5101602001
|
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 DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
IP
|
$54.00
|
|
Service Code
|
HCPCS 16020
|
Hospital Charge Code |
5101602001
|
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 DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
IP
|
$534.00
|
|
Service Code
|
HCPCS 16020
|
Hospital Charge Code |
7611602001
|
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 DRESS/DEBRID SMALL BURN NO ANES
|
Facility
|
OP
|
$534.00
|
|
Service Code
|
HCPCS 16020
|
Hospital Charge Code |
7611602001
|
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 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Facility
|
IP
|
$204.00
|
|
Service Code
|
HCPCS 41800
|
Hospital Charge Code |
5104180001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$127.91 |
Max. Negotiated Rate |
$204.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
Rate for Payer: Altius Auto/Workers Compensation |
$195.84
|
Rate for Payer: Altius Commercial |
$195.84
|
Rate for Payer: Beech Street Commercial |
$199.92
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.48
|
Rate for Payer: Cash Price |
$142.80
|
Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
Rate for Payer: Cigna of WY Commercial |
$199.92
|
Rate for Payer: Entrust Commercial |
$193.80
|
Rate for Payer: First Choice Health Commercial |
$193.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.64
|
Rate for Payer: HealthUtah PPO |
$204.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
Rate for Payer: Multiplan Medicare/VA |
$127.91
|
Rate for Payer: One Health Plan of WY PPO |
$199.92
|
Rate for Payer: PacificSource Commercial |
$183.60
|
Rate for Payer: PHCS PPO |
$199.92
|
Rate for Payer: Three Rivers PPO |
$153.00
|
Rate for Payer: TriWest Veterans Administration |
$134.64
|
Rate for Payer: United Healthcare Commercial |
$177.48
|
Rate for Payer: United Healthcare Medicare |
$134.64
|
Rate for Payer: WINHealth Partners Commercial |
$193.80
|
Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
HC DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Facility
|
OP
|
$204.00
|
|
Service Code
|
HCPCS 41800
|
Hospital Charge Code |
5104180001
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$112.40 |
Max. Negotiated Rate |
$204.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
Rate for Payer: Aetna of WY Medicare |
$134.64
|
Rate for Payer: Altius Auto/Workers Compensation |
$195.84
|
Rate for Payer: Altius Commercial |
$195.84
|
Rate for Payer: Beech Street Commercial |
$199.92
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.48
|
Rate for Payer: Cash Price |
$142.80
|
Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
Rate for Payer: Cigna of WY Commercial |
$199.92
|
Rate for Payer: Entrust Commercial |
$193.80
|
Rate for Payer: First Choice Health Commercial |
$193.80
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.32
|
Rate for Payer: HealthUtah PPO |
$204.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
Rate for Payer: Multiplan Medicare/VA |
$112.40
|
Rate for Payer: One Health Plan of WY PPO |
$199.92
|
Rate for Payer: PacificSource Commercial |
$183.60
|
Rate for Payer: PHCS PPO |
$199.92
|
Rate for Payer: Three Rivers PPO |
$153.00
|
Rate for Payer: TriWest Veterans Administration |
$118.32
|
Rate for Payer: United Healthcare Commercial |
$177.48
|
Rate for Payer: United Healthcare Medicare |
$118.32
|
Rate for Payer: WINHealth Partners Commercial |
$199.92
|
Rate for Payer: Wise Provider Network Commercial |
$193.80
|
|
HC DRUG ANALYSIS SERUM
|
Facility
|
IP
|
$1,430.00
|
|
Service Code
|
HCPCS 80307
|
Hospital Charge Code |
3018030730
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$896.61 |
Max. Negotiated Rate |
$1,430.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
Rate for Payer: Altius Commercial |
$1,372.80
|
Rate for Payer: Beech Street Commercial |
$1,401.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
Rate for Payer: Cash Price |
$1,001.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
Rate for Payer: Entrust Commercial |
$1,358.50
|
Rate for Payer: First Choice Health Commercial |
$1,358.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$943.80
|
Rate for Payer: HealthUtah PPO |
$1,430.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
Rate for Payer: Multiplan Medicare/VA |
$896.61
|
Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
Rate for Payer: PacificSource Commercial |
$1,287.00
|
Rate for Payer: PHCS PPO |
$1,401.40
|
Rate for Payer: Three Rivers PPO |
$1,072.50
|
Rate for Payer: TriWest Veterans Administration |
$943.80
|
Rate for Payer: United Healthcare Commercial |
$1,244.10
|
Rate for Payer: United Healthcare Medicare |
$943.80
|
Rate for Payer: WINHealth Partners Commercial |
$1,358.50
|
Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
HC DRUG ANALYSIS SERUM
|
Facility
|
OP
|
$1,430.00
|
|
Service Code
|
HCPCS 80307
|
Hospital Charge Code |
3018030730
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$787.93 |
Max. Negotiated Rate |
$1,430.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,401.40
|
Rate for Payer: Aetna of WY Medicare |
$943.80
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,372.80
|
Rate for Payer: Altius Commercial |
$1,372.80
|
Rate for Payer: Beech Street Commercial |
$1,401.40
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,174.03
|
Rate for Payer: Cash Price |
$1,001.00
|
Rate for Payer: ChoiceCare Network Commercial |
$1,387.10
|
Rate for Payer: Cigna of WY Commercial |
$1,401.40
|
Rate for Payer: Entrust Commercial |
$1,358.50
|
Rate for Payer: First Choice Health Commercial |
$1,358.50
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,358.50
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$829.40
|
Rate for Payer: HealthUtah PPO |
$1,430.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,387.10
|
Rate for Payer: Multiplan Medicare/VA |
$787.93
|
Rate for Payer: One Health Plan of WY PPO |
$1,401.40
|
Rate for Payer: PacificSource Commercial |
$1,287.00
|
Rate for Payer: PHCS PPO |
$1,401.40
|
Rate for Payer: Three Rivers PPO |
$1,072.50
|
Rate for Payer: TriWest Veterans Administration |
$829.40
|
Rate for Payer: United Healthcare Commercial |
$1,244.10
|
Rate for Payer: United Healthcare Medicare |
$829.40
|
Rate for Payer: WINHealth Partners Commercial |
$1,401.40
|
Rate for Payer: Wise Provider Network Commercial |
$1,358.50
|
|
HC DRUG ASSAY - ACETAMINOPHEN
|
Facility
|
OP
|
$300.00
|
|
Service Code
|
HCPCS 80143
|
Hospital Charge Code |
3018014301
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$165.30 |
Max. Negotiated Rate |
$300.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
Rate for Payer: Aetna of WY Medicare |
$198.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$288.00
|
Rate for Payer: Altius Commercial |
$288.00
|
Rate for Payer: Beech Street Commercial |
$294.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.30
|
Rate for Payer: Cash Price |
$210.00
|
Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
Rate for Payer: Cigna of WY Commercial |
$294.00
|
Rate for Payer: Entrust Commercial |
$285.00
|
Rate for Payer: First Choice Health Commercial |
$285.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.00
|
Rate for Payer: HealthUtah PPO |
$300.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
Rate for Payer: Multiplan Medicare/VA |
$165.30
|
Rate for Payer: One Health Plan of WY PPO |
$294.00
|
Rate for Payer: PacificSource Commercial |
$270.00
|
Rate for Payer: PHCS PPO |
$294.00
|
Rate for Payer: Three Rivers PPO |
$225.00
|
Rate for Payer: TriWest Veterans Administration |
$174.00
|
Rate for Payer: United Healthcare Commercial |
$261.00
|
Rate for Payer: United Healthcare Medicare |
$174.00
|
Rate for Payer: WINHealth Partners Commercial |
$294.00
|
Rate for Payer: Wise Provider Network Commercial |
$285.00
|
|