|
HC IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 87631
|
| Hospital Charge Code |
3098763101
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$267.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$389.76
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$333.33
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$235.48
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$223.71
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$235.48
|
| Rate for Payer: WINHealth Partners Commercial |
$397.88
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 RT PCR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 RT PCR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
3068763601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
3068763601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC ICU ROOM DAILY
|
Facility
|
IP
|
$9,180.00
|
|
| Hospital Charge Code |
2000000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$5,755.86 |
| Max. Negotiated Rate |
$9,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,996.40
|
| Rate for Payer: Aetna of WY Medicare |
$5,875.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,812.80
|
| Rate for Payer: Altius Commercial |
$8,812.80
|
| Rate for Payer: Beech Street Commercial |
$8,996.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,536.78
|
| Rate for Payer: Cash Price |
$6,426.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,904.60
|
| Rate for Payer: Cigna of WY Commercial |
$8,996.40
|
| Rate for Payer: Entrust Commercial |
$8,721.00
|
| Rate for Payer: First Choice Health Commercial |
$8,721.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,721.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,058.80
|
| Rate for Payer: HealthUtah PPO |
$9,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,904.60
|
| Rate for Payer: Multiplan Medicare/VA |
$5,755.86
|
| Rate for Payer: One Health Plan of WY PPO |
$8,996.40
|
| Rate for Payer: PacificSource Commercial |
$8,262.00
|
| Rate for Payer: PHCS PPO |
$8,996.40
|
| Rate for Payer: Three Rivers PPO |
$6,885.00
|
| Rate for Payer: TriWest Veterans Administration |
$6,058.80
|
| Rate for Payer: United Healthcare Commercial |
$7,986.60
|
| Rate for Payer: United Healthcare Medicare |
$6,058.80
|
| Rate for Payer: WINHealth Partners Commercial |
$8,721.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,721.00
|
|
|
HC I&D ARM/ELBOW INFECT BURSA
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
5102393101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC I&D ARM/ELBOW INFECT BURSA
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
5102393101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
7615642001
|
|
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 I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
7615642001
|
|
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 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
5102150101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$329.28
|
| Rate for Payer: Aetna of WY Medicare |
$221.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$322.56
|
| Rate for Payer: Altius Commercial |
$322.56
|
| Rate for Payer: Beech Street Commercial |
$329.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.86
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$325.92
|
| Rate for Payer: Cigna of WY Commercial |
$329.28
|
| Rate for Payer: Entrust Commercial |
$319.20
|
| Rate for Payer: First Choice Health Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.88
|
| Rate for Payer: HealthUtah PPO |
$336.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$325.92
|
| Rate for Payer: Multiplan Medicare/VA |
$185.14
|
| Rate for Payer: One Health Plan of WY PPO |
$329.28
|
| Rate for Payer: PacificSource Commercial |
$302.40
|
| Rate for Payer: PHCS PPO |
$329.28
|
| Rate for Payer: Three Rivers PPO |
$252.00
|
| Rate for Payer: TriWest Veterans Administration |
$194.88
|
| Rate for Payer: United Healthcare Commercial |
$292.32
|
| Rate for Payer: United Healthcare Medicare |
$194.88
|
| Rate for Payer: WINHealth Partners Commercial |
$329.28
|
| Rate for Payer: Wise Provider Network Commercial |
$319.20
|
|
|
HC I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
5102150101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.67 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$329.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$322.56
|
| Rate for Payer: Altius Commercial |
$322.56
|
| Rate for Payer: Beech Street Commercial |
$329.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.86
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$325.92
|
| Rate for Payer: Cigna of WY Commercial |
$329.28
|
| Rate for Payer: Entrust Commercial |
$319.20
|
| Rate for Payer: First Choice Health Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.76
|
| Rate for Payer: HealthUtah PPO |
$336.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$325.92
|
| Rate for Payer: Multiplan Medicare/VA |
$210.67
|
| Rate for Payer: One Health Plan of WY PPO |
$329.28
|
| Rate for Payer: PacificSource Commercial |
$302.40
|
| Rate for Payer: PHCS PPO |
$329.28
|
| Rate for Payer: Three Rivers PPO |
$252.00
|
| Rate for Payer: TriWest Veterans Administration |
$221.76
|
| Rate for Payer: United Healthcare Commercial |
$292.32
|
| Rate for Payer: United Healthcare Medicare |
$221.76
|
| Rate for Payer: WINHealth Partners Commercial |
$319.20
|
| Rate for Payer: Wise Provider Network Commercial |
$319.20
|
|
|
HC I&D MOUTH INTRA,SUBMANDIBULAR
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
7614100801
|
|
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 I&D MOUTH INTRA,SUBMANDIBULAR
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
7614100801
|
|
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 I&D OF BARTHOLINS GLAND ABSCESS
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
5105642001
|
|
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 I&D OF BARTHOLINS GLAND ABSCESS
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
5105642001
|
|
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 I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
7615640501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
7615640501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC I&D PERIANAL ABSCESS,SUPERFICIAL
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
7614605001
|
|
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 I&D PERIANAL ABSCESS,SUPERFICIAL
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 46050
|
| Hospital Charge Code |
7614605001
|
|
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 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
5102393001
|
|
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 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
5102393001
|
|
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 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7612393001
|
|
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 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
7612393001
|
|
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 I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 57023
|
| Hospital Charge Code |
5105702301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$504.16 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$896.70
|
| Rate for Payer: Aetna of WY Medicare |
$603.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$878.40
|
| Rate for Payer: Altius Commercial |
$878.40
|
| Rate for Payer: Beech Street Commercial |
$896.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$751.22
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$887.55
|
| Rate for Payer: Cigna of WY Commercial |
$896.70
|
| Rate for Payer: Entrust Commercial |
$869.25
|
| Rate for Payer: First Choice Health Commercial |
$869.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$869.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.70
|
| Rate for Payer: HealthUtah PPO |
$915.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$887.55
|
| Rate for Payer: Multiplan Medicare/VA |
$504.16
|
| Rate for Payer: One Health Plan of WY PPO |
$896.70
|
| Rate for Payer: PacificSource Commercial |
$823.50
|
| Rate for Payer: PHCS PPO |
$896.70
|
| Rate for Payer: Three Rivers PPO |
$686.25
|
| Rate for Payer: TriWest Veterans Administration |
$530.70
|
| Rate for Payer: United Healthcare Commercial |
$796.05
|
| Rate for Payer: United Healthcare Medicare |
$530.70
|
| Rate for Payer: WINHealth Partners Commercial |
$896.70
|
| Rate for Payer: Wise Provider Network Commercial |
$869.25
|
|
