|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$784.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$768.00
|
| Rate for Payer: Altius Commercial |
$768.00
|
| Rate for Payer: Beech Street Commercial |
$784.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$656.80
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$776.00
|
| Rate for Payer: Cigna of WY Commercial |
$784.00
|
| Rate for Payer: Entrust Commercial |
$760.00
|
| Rate for Payer: First Choice Health Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$760.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.00
|
| Rate for Payer: HealthUtah PPO |
$800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$776.00
|
| Rate for Payer: Multiplan Medicare/VA |
$501.60
|
| Rate for Payer: One Health Plan of WY PPO |
$784.00
|
| Rate for Payer: PacificSource Commercial |
$720.00
|
| Rate for Payer: PHCS PPO |
$784.00
|
| Rate for Payer: Three Rivers PPO |
$600.00
|
| Rate for Payer: TriWest Veterans Administration |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$528.00
|
| Rate for Payer: WINHealth Partners Commercial |
$760.00
|
| Rate for Payer: Wise Provider Network Commercial |
$760.00
|
|
|
HC IMMUNOTHERAPY, 2+ INJECTIONS
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
5109511701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.69
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC IMMUNOTHERAPY, 2+ INJECTIONS
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
5109511701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.38
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$26.96
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.38
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$28.38
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC IMMUNOTHERAPY, ONE INJECTION
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
5109511501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Aetna of WY Medicare |
$13.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.16
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.18
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.57
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$12.18
|
| Rate for Payer: United Healthcare Commercial |
$18.27
|
| Rate for Payer: United Healthcare Medicare |
$12.18
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
HC IMMUNOTHERAPY, ONE INJECTION
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
5109511501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.16
|
| Rate for Payer: Altius Commercial |
$20.16
|
| Rate for Payer: Beech Street Commercial |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: Entrust Commercial |
$19.95
|
| Rate for Payer: First Choice Health Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.86
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$13.17
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$20.58
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.86
|
| Rate for Payer: United Healthcare Commercial |
$18.27
|
| Rate for Payer: United Healthcare Medicare |
$13.86
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
| Rate for Payer: Wise Provider Network Commercial |
$19.95
|
|
|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.30
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$285.28
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$300.30
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$300.30
|
| Rate for Payer: WINHealth Partners Commercial |
$432.25
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$445.90
|
| Rate for Payer: Aetna of WY Medicare |
$300.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$436.80
|
| Rate for Payer: Altius Commercial |
$436.80
|
| Rate for Payer: Beech Street Commercial |
$445.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.56
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.35
|
| Rate for Payer: Cigna of WY Commercial |
$445.90
|
| Rate for Payer: Entrust Commercial |
$432.25
|
| Rate for Payer: First Choice Health Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.90
|
| Rate for Payer: HealthUtah PPO |
$455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.35
|
| Rate for Payer: Multiplan Medicare/VA |
$250.70
|
| Rate for Payer: One Health Plan of WY PPO |
$445.90
|
| Rate for Payer: PacificSource Commercial |
$409.50
|
| Rate for Payer: PHCS PPO |
$445.90
|
| Rate for Payer: Three Rivers PPO |
$341.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.90
|
| Rate for Payer: United Healthcare Commercial |
$395.85
|
| Rate for Payer: United Healthcare Medicare |
$263.90
|
| Rate for Payer: WINHealth Partners Commercial |
$445.90
|
| Rate for Payer: Wise Provider Network Commercial |
$432.25
|
|
|
HC INCISE EXTERNAL HEMORRHOID
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
7614608301
|
|
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 INCISE EXTERNAL HEMORRHOID
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
7614608301
|
|
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 INCISE FINGER TENDON SHEATH
|
Facility
|
IP
|
$2,063.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
5102605501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,293.50 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,021.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,980.48
|
| Rate for Payer: Altius Commercial |
$1,980.48
|
| Rate for Payer: Beech Street Commercial |
$2,021.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,693.72
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,001.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,021.74
|
| Rate for Payer: Entrust Commercial |
$1,959.85
|
| Rate for Payer: First Choice Health Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,361.58
|
| Rate for Payer: HealthUtah PPO |
$2,063.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,001.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,293.50
|
| Rate for Payer: One Health Plan of WY PPO |
$2,021.74
|
| Rate for Payer: PacificSource Commercial |
$1,856.70
|
| Rate for Payer: PHCS PPO |
$2,021.74
|
| Rate for Payer: Three Rivers PPO |
$1,547.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,361.58
|
| Rate for Payer: United Healthcare Commercial |
$1,794.81
|
| Rate for Payer: United Healthcare Medicare |
$1,361.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,959.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,959.85
|
|
|
HC INCISE FINGER TENDON SHEATH
|
Facility
|
OP
|
$2,063.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
5102605501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,136.71 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,021.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,361.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,980.48
|
| Rate for Payer: Altius Commercial |
$1,980.48
|
| Rate for Payer: Beech Street Commercial |
$2,021.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,693.72
|
| Rate for Payer: Cash Price |
$1,444.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,001.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,021.74
|
| Rate for Payer: Entrust Commercial |
$1,959.85
|
| Rate for Payer: First Choice Health Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,959.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,196.54
|
| Rate for Payer: HealthUtah PPO |
$2,063.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,001.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,136.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2,021.74
|
| Rate for Payer: PacificSource Commercial |
$1,856.70
|
| Rate for Payer: PHCS PPO |
$2,021.74
|
| Rate for Payer: Three Rivers PPO |
$1,547.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,196.54
|
| Rate for Payer: United Healthcare Commercial |
$1,794.81
|
| Rate for Payer: United Healthcare Medicare |
$1,196.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2,021.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,959.85
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
5101110601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.94
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$36.99
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.94
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$38.94
|
| Rate for Payer: WINHealth Partners Commercial |
$56.05
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
5101110601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.51 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$38.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.22
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$32.51
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.22
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$34.22
|
| Rate for Payer: WINHealth Partners Commercial |
$57.82
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
5101018001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$170.88
|
| Rate for Payer: Altius Commercial |
$170.88
|
| Rate for Payer: Beech Street Commercial |
$174.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.14
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: Entrust Commercial |
$169.10
|
| Rate for Payer: First Choice Health Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.48
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$111.61
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$174.44
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$117.48
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$117.48
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
| Rate for Payer: Wise Provider Network Commercial |
$169.10
|
|
|
HC INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
5101018001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$117.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$170.88
|
| Rate for Payer: Altius Commercial |
$170.88
|
| Rate for Payer: Beech Street Commercial |
$174.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.14
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: Entrust Commercial |
$169.10
|
| Rate for Payer: First Choice Health Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.24
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$98.08
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$174.44
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.24
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$103.24
|
| Rate for Payer: WINHealth Partners Commercial |
$174.44
|
| Rate for Payer: Wise Provider Network Commercial |
$169.10
|
|
|
HC INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
5102760301
|
|
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 INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 27603
|
| Hospital Charge Code |
5102760301
|
|
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 INCISION DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
5101014001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$78.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.02
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$65.57
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$69.02
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$69.02
|
| Rate for Payer: WINHealth Partners Commercial |
$116.62
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC INCISION DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
5101014001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.61 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$114.24
|
| Rate for Payer: Altius Commercial |
$114.24
|
| Rate for Payer: Beech Street Commercial |
$116.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: Entrust Commercial |
$113.05
|
| Rate for Payer: First Choice Health Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.54
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$74.61
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$116.62
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$78.54
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$78.54
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
| Rate for Payer: Wise Provider Network Commercial |
$113.05
|
|
|
HC INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
5101008101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.84 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.12
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.21
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.52
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$107.84
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$113.52
|
| Rate for Payer: United Healthcare Commercial |
$149.64
|
| Rate for Payer: United Healthcare Medicare |
$113.52
|
| Rate for Payer: WINHealth Partners Commercial |
$163.40
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
5101008101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.77 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$113.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.12
|
| Rate for Payer: Altius Commercial |
$165.12
|
| Rate for Payer: Beech Street Commercial |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.21
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: Entrust Commercial |
$163.40
|
| Rate for Payer: First Choice Health Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.76
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$94.77
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$168.56
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$99.76
|
| Rate for Payer: United Healthcare Commercial |
$149.64
|
| Rate for Payer: United Healthcare Medicare |
$99.76
|
| Rate for Payer: WINHealth Partners Commercial |
$168.56
|
| Rate for Payer: Wise Provider Network Commercial |
$163.40
|
|
|
HC INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
5101008001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.98
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$64.58
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.98
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$67.98
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
5101008001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.74
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$56.75
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.74
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$59.74
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC INCISION DRAIN SKIN ABSCESS COMPLEX
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
5101006101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.72
|
| Rate for Payer: Altius Commercial |
$174.72
|
| Rate for Payer: Beech Street Commercial |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.42
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: Entrust Commercial |
$172.90
|
| Rate for Payer: First Choice Health Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.12
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: Multiplan Medicare/VA |
$114.11
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PHCS PPO |
$178.36
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: TriWest Veterans Administration |
$120.12
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: United Healthcare Medicare |
$120.12
|
| Rate for Payer: WINHealth Partners Commercial |
$172.90
|
| Rate for Payer: Wise Provider Network Commercial |
$172.90
|
|
|
HC INCISION DRAIN SKIN ABSCESS COMPLEX
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
5101006101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.28 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Aetna of WY Medicare |
$120.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.72
|
| Rate for Payer: Altius Commercial |
$174.72
|
| Rate for Payer: Beech Street Commercial |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.42
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: Entrust Commercial |
$172.90
|
| Rate for Payer: First Choice Health Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.56
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: Multiplan Medicare/VA |
$100.28
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PHCS PPO |
$178.36
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: TriWest Veterans Administration |
$105.56
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: United Healthcare Medicare |
$105.56
|
| Rate for Payer: WINHealth Partners Commercial |
$178.36
|
| Rate for Payer: Wise Provider Network Commercial |
$172.90
|
|
