|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
5101142601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.97 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.52
|
| Rate for Payer: Aetna of WY Medicare |
$180.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$263.04
|
| Rate for Payer: Altius Commercial |
$263.04
|
| Rate for Payer: Beech Street Commercial |
$268.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.95
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.78
|
| Rate for Payer: Cigna of WY Commercial |
$268.52
|
| Rate for Payer: Entrust Commercial |
$260.30
|
| Rate for Payer: First Choice Health Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.92
|
| Rate for Payer: HealthUtah PPO |
$274.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.78
|
| Rate for Payer: Multiplan Medicare/VA |
$150.97
|
| Rate for Payer: One Health Plan of WY PPO |
$268.52
|
| Rate for Payer: PacificSource Commercial |
$246.60
|
| Rate for Payer: PHCS PPO |
$268.52
|
| Rate for Payer: Three Rivers PPO |
$205.50
|
| Rate for Payer: TriWest Veterans Administration |
$158.92
|
| Rate for Payer: United Healthcare Commercial |
$238.38
|
| Rate for Payer: United Healthcare Medicare |
$158.92
|
| Rate for Payer: WINHealth Partners Commercial |
$268.52
|
| Rate for Payer: Wise Provider Network Commercial |
$260.30
|
|
|
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
5101142601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$268.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$263.04
|
| Rate for Payer: Altius Commercial |
$263.04
|
| Rate for Payer: Beech Street Commercial |
$268.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.95
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$265.78
|
| Rate for Payer: Cigna of WY Commercial |
$268.52
|
| Rate for Payer: Entrust Commercial |
$260.30
|
| Rate for Payer: First Choice Health Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$260.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.84
|
| Rate for Payer: HealthUtah PPO |
$274.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$265.78
|
| Rate for Payer: Multiplan Medicare/VA |
$171.80
|
| Rate for Payer: One Health Plan of WY PPO |
$268.52
|
| Rate for Payer: PacificSource Commercial |
$246.60
|
| Rate for Payer: PHCS PPO |
$268.52
|
| Rate for Payer: Three Rivers PPO |
$205.50
|
| Rate for Payer: TriWest Veterans Administration |
$180.84
|
| Rate for Payer: United Healthcare Commercial |
$238.38
|
| Rate for Payer: United Healthcare Medicare |
$180.84
|
| Rate for Payer: WINHealth Partners Commercial |
$260.30
|
| Rate for Payer: Wise Provider Network Commercial |
$260.30
|
|
|
HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
5101140301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.04
|
| Rate for Payer: Aetna of WY Medicare |
$97.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.08
|
| Rate for Payer: Altius Commercial |
$142.08
|
| Rate for Payer: Beech Street Commercial |
$145.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$121.51
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$143.56
|
| Rate for Payer: Cigna of WY Commercial |
$145.04
|
| Rate for Payer: Entrust Commercial |
$140.60
|
| Rate for Payer: First Choice Health Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.84
|
| Rate for Payer: HealthUtah PPO |
$148.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$143.56
|
| Rate for Payer: Multiplan Medicare/VA |
$81.55
|
| Rate for Payer: One Health Plan of WY PPO |
$145.04
|
| Rate for Payer: PacificSource Commercial |
$133.20
|
| Rate for Payer: PHCS PPO |
$145.04
|
| Rate for Payer: Three Rivers PPO |
$111.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.84
|
| Rate for Payer: United Healthcare Commercial |
$128.76
|
| Rate for Payer: United Healthcare Medicare |
$85.84
|
| Rate for Payer: WINHealth Partners Commercial |
$145.04
|
| Rate for Payer: Wise Provider Network Commercial |
$140.60
|
|
|
HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
5101140301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.08
|
| Rate for Payer: Altius Commercial |
$142.08
|
| Rate for Payer: Beech Street Commercial |
$145.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$121.51
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$143.56
|
| Rate for Payer: Cigna of WY Commercial |
$145.04
|
| Rate for Payer: Entrust Commercial |
$140.60
|
| Rate for Payer: First Choice Health Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.68
|
| Rate for Payer: HealthUtah PPO |
$148.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$143.56
|
| Rate for Payer: Multiplan Medicare/VA |
$92.80
|
| Rate for Payer: One Health Plan of WY PPO |
$145.04
|
| Rate for Payer: PacificSource Commercial |
$133.20
|
| Rate for Payer: PHCS PPO |
$145.04
|
| Rate for Payer: Three Rivers PPO |
$111.00
|
| Rate for Payer: TriWest Veterans Administration |
$97.68
|
| Rate for Payer: United Healthcare Commercial |
$128.76
|
| Rate for Payer: United Healthcare Medicare |
$97.68
|
| Rate for Payer: WINHealth Partners Commercial |
$140.60
|
| Rate for Payer: Wise Provider Network Commercial |
$140.60
|
|
|
HC EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
5101140401
|
|
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 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
5101140401
|
|
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 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
5101144301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$116.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$169.92
|
| Rate for Payer: Altius Commercial |
$169.92
|
| Rate for Payer: Beech Street Commercial |
$173.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.32
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: Entrust Commercial |
$168.15
|
| Rate for Payer: First Choice Health Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.66
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$97.53
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$173.46
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$102.66
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: United Healthcare Medicare |
$102.66
|
| Rate for Payer: WINHealth Partners Commercial |
$173.46
|
| Rate for Payer: Wise Provider Network Commercial |
$168.15
|
|
|
HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
5101144301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.98 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$169.92
|
| Rate for Payer: Altius Commercial |
$169.92
|
| Rate for Payer: Beech Street Commercial |
$173.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.32
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: Entrust Commercial |
$168.15
|
| Rate for Payer: First Choice Health Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.82
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$110.98
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$173.46
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$116.82
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: United Healthcare Medicare |
$116.82
|
| Rate for Payer: WINHealth Partners Commercial |
$168.15
|
| Rate for Payer: Wise Provider Network Commercial |
$168.15
|
|
|
HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
5101144401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.26
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$108.55
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$114.26
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
5101144401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.02
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.52
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.02
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$130.02
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC EXC FRENUM LABIAL/BUCCAL
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
5104081901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.54
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$137.31
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.54
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$144.54
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC EXC FRENUM LABIAL/BUCCAL
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
5104081901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$144.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.02
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$120.67
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.02
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$214.62
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC EXCISION EXTERNAL EAR COMPLETE AMPUTATION
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 69120
|
| Hospital Charge Code |
5106912001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.32
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$252.05
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$265.32
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$265.32
|
| Rate for Payer: WINHealth Partners Commercial |
$381.90
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC EXCISION EXTERNAL EAR COMPLETE AMPUTATION
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 69120
|
| Hospital Charge Code |
5106912001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Aetna of WY Medicare |
$265.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$385.92
|
| Rate for Payer: Altius Commercial |
$385.92
|
| Rate for Payer: Beech Street Commercial |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$330.04
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: Entrust Commercial |
$381.90
|
| Rate for Payer: First Choice Health Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.16
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$221.50
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$393.96
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$233.16
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$233.16
|
| Rate for Payer: WINHealth Partners Commercial |
$393.96
|
| Rate for Payer: Wise Provider Network Commercial |
$381.90
|
|
|
HC EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
5106911001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.03 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$327.32
|
| Rate for Payer: Aetna of WY Medicare |
$220.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$320.64
|
| Rate for Payer: Altius Commercial |
$320.64
|
| Rate for Payer: Beech Street Commercial |
$327.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.21
|
| Rate for Payer: Cash Price |
$233.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.98
|
| Rate for Payer: Cigna of WY Commercial |
$327.32
|
| Rate for Payer: Entrust Commercial |
$317.30
|
| Rate for Payer: First Choice Health Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.72
|
| Rate for Payer: HealthUtah PPO |
$334.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.98
|
| Rate for Payer: Multiplan Medicare/VA |
$184.03
|
| Rate for Payer: One Health Plan of WY PPO |
$327.32
|
| Rate for Payer: PacificSource Commercial |
$300.60
|
| Rate for Payer: PHCS PPO |
$327.32
|
| Rate for Payer: Three Rivers PPO |
$250.50
|
| Rate for Payer: TriWest Veterans Administration |
$193.72
|
| Rate for Payer: United Healthcare Commercial |
$290.58
|
| Rate for Payer: United Healthcare Medicare |
$193.72
|
| Rate for Payer: WINHealth Partners Commercial |
$327.32
|
| Rate for Payer: Wise Provider Network Commercial |
$317.30
|
|
|
HC EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
5106911001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.42 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$327.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$320.64
|
| Rate for Payer: Altius Commercial |
$320.64
|
| Rate for Payer: Beech Street Commercial |
$327.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.21
|
| Rate for Payer: Cash Price |
$233.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.98
|
| Rate for Payer: Cigna of WY Commercial |
$327.32
|
| Rate for Payer: Entrust Commercial |
$317.30
|
| Rate for Payer: First Choice Health Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$317.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.44
|
| Rate for Payer: HealthUtah PPO |
$334.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.98
|
| Rate for Payer: Multiplan Medicare/VA |
$209.42
|
| Rate for Payer: One Health Plan of WY PPO |
$327.32
|
| Rate for Payer: PacificSource Commercial |
$300.60
|
| Rate for Payer: PHCS PPO |
$327.32
|
| Rate for Payer: Three Rivers PPO |
$250.50
|
| Rate for Payer: TriWest Veterans Administration |
$220.44
|
| Rate for Payer: United Healthcare Commercial |
$290.58
|
| Rate for Payer: United Healthcare Medicare |
$220.44
|
| Rate for Payer: WINHealth Partners Commercial |
$317.30
|
| Rate for Payer: Wise Provider Network Commercial |
$317.30
|
|
|
HC EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
5101145001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.51 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.96
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$160.51
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$168.96
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$168.96
|
| Rate for Payer: WINHealth Partners Commercial |
$243.20
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
5101145001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.06 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Aetna of WY Medicare |
$168.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.76
|
| Rate for Payer: Altius Commercial |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$250.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.18
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: Entrust Commercial |
$243.20
|
| Rate for Payer: First Choice Health Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.48
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$141.06
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$250.88
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$148.48
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$148.48
|
| Rate for Payer: WINHealth Partners Commercial |
$250.88
|
| Rate for Payer: Wise Provider Network Commercial |
$243.20
|
|
|
HC EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
5101147001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$270.72
|
| Rate for Payer: Altius Commercial |
$270.72
|
| Rate for Payer: Beech Street Commercial |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: Entrust Commercial |
$267.90
|
| Rate for Payer: First Choice Health Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.12
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$176.81
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$276.36
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$186.12
|
| Rate for Payer: United Healthcare Commercial |
$245.34
|
| Rate for Payer: United Healthcare Medicare |
$186.12
|
| Rate for Payer: WINHealth Partners Commercial |
$267.90
|
| Rate for Payer: Wise Provider Network Commercial |
$267.90
|
|
|
HC EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
5101147001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.38 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Aetna of WY Medicare |
$186.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$270.72
|
| Rate for Payer: Altius Commercial |
$270.72
|
| Rate for Payer: Beech Street Commercial |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: Entrust Commercial |
$267.90
|
| Rate for Payer: First Choice Health Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.56
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$155.38
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$276.36
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$163.56
|
| Rate for Payer: United Healthcare Commercial |
$245.34
|
| Rate for Payer: United Healthcare Medicare |
$163.56
|
| Rate for Payer: WINHealth Partners Commercial |
$276.36
|
| Rate for Payer: Wise Provider Network Commercial |
$267.90
|
|
|
HC EXCISION LESION CONJUNCTIVA <1 CM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 68110
|
| Hospital Charge Code |
5106811001
|
|
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 EXCISION LESION CONJUNCTIVA <1 CM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 68110
|
| Hospital Charge Code |
5106811001
|
|
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 EXCISION LESION TONGUE W/O CLOSURE
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
5104111001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.26
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$100.95
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.26
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$106.26
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
