|
HC EXCISION LESION TONGUE W/O CLOSURE
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
5104111001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.71 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$106.26
|
| 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 |
$93.38
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$88.71
|
| 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 |
$93.38
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$93.38
|
| Rate for Payer: WINHealth Partners Commercial |
$157.78
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC EXCISION LINGUAL FRENUM FRENECTOMY
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
5104111501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Aetna of WY Medicare |
$120.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
| Rate for Payer: Altius Commercial |
$175.68
|
| Rate for Payer: Beech Street Commercial |
$179.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: Entrust Commercial |
$173.85
|
| Rate for Payer: First Choice Health Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$179.34
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.14
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$106.14
|
| Rate for Payer: WINHealth Partners Commercial |
$179.34
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC EXCISION LINGUAL FRENUM FRENECTOMY
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
5104111501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$175.68
|
| Rate for Payer: Altius Commercial |
$175.68
|
| Rate for Payer: Beech Street Commercial |
$179.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$150.24
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: Entrust Commercial |
$173.85
|
| Rate for Payer: First Choice Health Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.78
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$114.74
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$179.34
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$120.78
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$120.78
|
| Rate for Payer: WINHealth Partners Commercial |
$173.85
|
| Rate for Payer: Wise Provider Network Commercial |
$173.85
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
5101164001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$83.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.96
|
| Rate for Payer: Altius Commercial |
$120.96
|
| Rate for Payer: Beech Street Commercial |
$123.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.45
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: Entrust Commercial |
$119.70
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.08
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$69.43
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$123.48
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$73.08
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Medicare |
$73.08
|
| Rate for Payer: WINHealth Partners Commercial |
$123.48
|
| Rate for Payer: Wise Provider Network Commercial |
$119.70
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
5101164001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.96
|
| Rate for Payer: Altius Commercial |
$120.96
|
| Rate for Payer: Beech Street Commercial |
$123.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.45
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: Entrust Commercial |
$119.70
|
| Rate for Payer: First Choice Health Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.16
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$79.00
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PHCS PPO |
$123.48
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$83.16
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Medicare |
$83.16
|
| Rate for Payer: WINHealth Partners Commercial |
$119.70
|
| Rate for Payer: Wise Provider Network Commercial |
$119.70
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
5101164401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.44 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$271.68
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$232.34
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.78
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$177.44
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$186.78
|
| Rate for Payer: United Healthcare Commercial |
$246.21
|
| Rate for Payer: United Healthcare Medicare |
$186.78
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
5101164401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.93 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$271.68
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$232.34
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.14
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$155.93
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$164.14
|
| Rate for Payer: United Healthcare Commercial |
$246.21
|
| Rate for Payer: United Healthcare Medicare |
$164.14
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
5101164601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Aetna of WY Medicare |
$316.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.40
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$264.48
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.40
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$278.40
|
| Rate for Payer: WINHealth Partners Commercial |
$470.40
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
5101164601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.80
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$300.96
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$316.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$316.80
|
| Rate for Payer: WINHealth Partners Commercial |
$456.00
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
5101162001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.49 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.12
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.16
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.52
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$76.49
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.52
|
| Rate for Payer: United Healthcare Commercial |
$106.14
|
| Rate for Payer: United Healthcare Medicare |
$80.52
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
5101162001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.12
|
| Rate for Payer: Altius Commercial |
$117.12
|
| Rate for Payer: Beech Street Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.16
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: Entrust Commercial |
$115.90
|
| Rate for Payer: First Choice Health Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$119.56
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$106.14
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$119.56
|
| Rate for Payer: Wise Provider Network Commercial |
$115.90
|
|
|
HC EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
5101162301
|
|
Hospital Revenue Code
|
510
|
| 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 EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
5101162301
|
|
Hospital Revenue Code
|
510
|
| 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 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
5101162601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.34 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$282.24
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$241.37
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.04
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$184.34
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$194.04
|
| Rate for Payer: United Healthcare Commercial |
$255.78
|
| Rate for Payer: United Healthcare Medicare |
$194.04
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
|
HC EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
5101162601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$282.24
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$241.37
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.52
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$161.99
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.52
|
| Rate for Payer: United Healthcare Commercial |
$255.78
|
| Rate for Payer: United Healthcare Medicare |
$170.52
|
| Rate for Payer: WINHealth Partners Commercial |
$288.12
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
|
HC EXCISION NAIL MATRIX PRT/CMPL PERMANENT REMOVAL
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5101175001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.92
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.32
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$63.95
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.32
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$67.32
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC EXCISION NAIL MATRIX PRT/CMPL PERMANENT REMOVAL
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
5101175001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$67.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.92
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.16
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$56.20
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.16
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$59.16
|
| Rate for Payer: WINHealth Partners Commercial |
$99.96
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC EXCISION OF NAIL FOLD, TOE
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
7611176501
|
|
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 EXCISION OF NAIL FOLD, TOE
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
7611176501
|
|
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 EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
5101177001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
5101177001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC EXCISION TENDON SHEATH LESION HAND/FINGER
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
5102616001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,320.20 |
| Max. Negotiated Rate |
$2,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,348.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,581.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,300.16
|
| Rate for Payer: Altius Commercial |
$2,300.16
|
| Rate for Payer: Beech Street Commercial |
$2,348.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,967.12
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,324.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,348.08
|
| Rate for Payer: Entrust Commercial |
$2,276.20
|
| Rate for Payer: First Choice Health Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,389.68
|
| Rate for Payer: HealthUtah PPO |
$2,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,324.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1,320.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,348.08
|
| Rate for Payer: PacificSource Commercial |
$2,156.40
|
| Rate for Payer: PHCS PPO |
$2,348.08
|
| Rate for Payer: Three Rivers PPO |
$1,797.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,389.68
|
| Rate for Payer: United Healthcare Commercial |
$2,084.52
|
| Rate for Payer: United Healthcare Medicare |
$1,389.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,348.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2,276.20
|
|
|
HC EXCISION TENDON SHEATH LESION HAND/FINGER
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
5102616001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,502.29 |
| Max. Negotiated Rate |
$2,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,348.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,300.16
|
| Rate for Payer: Altius Commercial |
$2,300.16
|
| Rate for Payer: Beech Street Commercial |
$2,348.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,967.12
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,324.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,348.08
|
| Rate for Payer: Entrust Commercial |
$2,276.20
|
| Rate for Payer: First Choice Health Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,581.36
|
| Rate for Payer: HealthUtah PPO |
$2,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,324.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1,502.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,348.08
|
| Rate for Payer: PacificSource Commercial |
$2,156.40
|
| Rate for Payer: PHCS PPO |
$2,348.08
|
| Rate for Payer: Three Rivers PPO |
$1,797.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,581.36
|
| Rate for Payer: United Healthcare Commercial |
$2,084.52
|
| Rate for Payer: United Healthcare Medicare |
$1,581.36
|
| Rate for Payer: WINHealth Partners Commercial |
$2,276.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2,276.20
|
|
|
HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
7614632001
|
|
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 EXCISION THROMBOSED HEMORRHOID, EXTERNAL
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
5104632001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$361.15 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$552.96
|
| Rate for Payer: Altius Commercial |
$552.96
|
| Rate for Payer: Beech Street Commercial |
$564.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.90
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: Entrust Commercial |
$547.20
|
| Rate for Payer: First Choice Health Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$380.16
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$361.15
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$564.48
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$380.16
|
| Rate for Payer: United Healthcare Commercial |
$501.12
|
| Rate for Payer: United Healthcare Medicare |
$380.16
|
| Rate for Payer: WINHealth Partners Commercial |
$547.20
|
| Rate for Payer: Wise Provider Network Commercial |
$547.20
|
|
