|
HC REMOTE 30 DAY ECG REV/REPORT - CARDIAC EVENT MONITOR
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 93270
|
| Hospital Charge Code |
7319327001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC REMOTE 30 DAY ECG REV/REPORT - CARDIAC EVENT MONITOR
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 93270
|
| Hospital Charge Code |
7319327001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC REMOVAL DEEP IMPLANT
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
5102068001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,187.40 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,422.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,068.80
|
| Rate for Payer: Altius Commercial |
$2,068.80
|
| Rate for Payer: Beech Street Commercial |
$2,111.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,769.26
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: Entrust Commercial |
$2,047.25
|
| Rate for Payer: First Choice Health Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,249.90
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,187.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,111.90
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,249.90
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$1,249.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,111.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,047.25
|
|
|
HC REMOVAL DEEP IMPLANT
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
5102068001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,351.18 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,068.80
|
| Rate for Payer: Altius Commercial |
$2,068.80
|
| Rate for Payer: Beech Street Commercial |
$2,111.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,769.26
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: Entrust Commercial |
$2,047.25
|
| Rate for Payer: First Choice Health Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,422.30
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,351.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,111.90
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,422.30
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$1,422.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,047.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,047.25
|
|
|
HC REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
5102069401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.65 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.08
|
| Rate for Payer: Aetna of WY Medicare |
$228.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$332.16
|
| Rate for Payer: Altius Commercial |
$332.16
|
| Rate for Payer: Beech Street Commercial |
$339.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.07
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.62
|
| Rate for Payer: Cigna of WY Commercial |
$339.08
|
| Rate for Payer: Entrust Commercial |
$328.70
|
| Rate for Payer: First Choice Health Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.68
|
| Rate for Payer: HealthUtah PPO |
$346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.62
|
| Rate for Payer: Multiplan Medicare/VA |
$190.65
|
| Rate for Payer: One Health Plan of WY PPO |
$339.08
|
| Rate for Payer: PacificSource Commercial |
$311.40
|
| Rate for Payer: PHCS PPO |
$339.08
|
| Rate for Payer: Three Rivers PPO |
$259.50
|
| Rate for Payer: TriWest Veterans Administration |
$200.68
|
| Rate for Payer: United Healthcare Commercial |
$301.02
|
| Rate for Payer: United Healthcare Medicare |
$200.68
|
| Rate for Payer: WINHealth Partners Commercial |
$339.08
|
| Rate for Payer: Wise Provider Network Commercial |
$328.70
|
|
|
HC REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
5102069401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.94 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$332.16
|
| Rate for Payer: Altius Commercial |
$332.16
|
| Rate for Payer: Beech Street Commercial |
$339.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.07
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.62
|
| Rate for Payer: Cigna of WY Commercial |
$339.08
|
| Rate for Payer: Entrust Commercial |
$328.70
|
| Rate for Payer: First Choice Health Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.36
|
| Rate for Payer: HealthUtah PPO |
$346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.62
|
| Rate for Payer: Multiplan Medicare/VA |
$216.94
|
| Rate for Payer: One Health Plan of WY PPO |
$339.08
|
| Rate for Payer: PacificSource Commercial |
$311.40
|
| Rate for Payer: PHCS PPO |
$339.08
|
| Rate for Payer: Three Rivers PPO |
$259.50
|
| Rate for Payer: TriWest Veterans Administration |
$228.36
|
| Rate for Payer: United Healthcare Commercial |
$301.02
|
| Rate for Payer: United Healthcare Medicare |
$228.36
|
| Rate for Payer: WINHealth Partners Commercial |
$328.70
|
| Rate for Payer: Wise Provider Network Commercial |
$328.70
|
|
|
HC REMOVAL FB EAR CANAL;WO ANESTH
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$36.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.76
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.48
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$30.86
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$32.48
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$32.48
|
| Rate for Payer: WINHealth Partners Commercial |
$54.88
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
|
HC REMOVAL FB EAR CANAL;WO ANESTH
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 69200 50
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$73.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$107.52
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.95
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.96
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$61.71
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$64.96
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$64.96
|
| Rate for Payer: WINHealth Partners Commercial |
$109.76
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC REMOVAL FB EAR CANAL;WO ANESTH
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 69200 50
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.22 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$107.52
|
| Rate for Payer: Altius Commercial |
$107.52
|
| Rate for Payer: Beech Street Commercial |
$109.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.95
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: Entrust Commercial |
$106.40
|
| Rate for Payer: First Choice Health Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.92
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$70.22
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$109.76
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$73.92
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$73.92
|
| Rate for Payer: WINHealth Partners Commercial |
$106.40
|
| Rate for Payer: Wise Provider Network Commercial |
$106.40
|
|
|
HC REMOVAL FB EAR CANAL;WO ANESTH
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$53.76
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.96
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$35.11
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$36.96
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
| Rate for Payer: WINHealth Partners Commercial |
$53.20
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
|
HC REMOVAL FB EXT EYE CONJUCTIVAL EMBEDDED
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$365.31 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$649.74
|
| Rate for Payer: Aetna of WY Medicare |
$437.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$636.48
|
| Rate for Payer: Altius Commercial |
$636.48
|
| Rate for Payer: Beech Street Commercial |
$649.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$464.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$643.11
|
| Rate for Payer: Cigna of WY Commercial |
$649.74
|
| Rate for Payer: Entrust Commercial |
$629.85
|
| Rate for Payer: First Choice Health Commercial |
$629.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$629.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$384.54
|
| Rate for Payer: HealthUtah PPO |
$663.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$643.11
|
| Rate for Payer: Multiplan Medicare/VA |
$365.31
|
| Rate for Payer: One Health Plan of WY PPO |
$649.74
|
| Rate for Payer: PacificSource Commercial |
$596.70
|
| Rate for Payer: PHCS PPO |
$649.74
|
| Rate for Payer: Three Rivers PPO |
$497.25
|
| Rate for Payer: TriWest Veterans Administration |
$384.54
|
| Rate for Payer: United Healthcare Commercial |
$576.81
|
| Rate for Payer: United Healthcare Medicare |
$384.54
|
| Rate for Payer: WINHealth Partners Commercial |
$649.74
|
| Rate for Payer: Wise Provider Network Commercial |
$629.85
|
|
|
HC REMOVAL FB EXT EYE CONJUCTIVAL EMBEDDED
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$415.70 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$649.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$636.48
|
| Rate for Payer: Altius Commercial |
$636.48
|
| Rate for Payer: Beech Street Commercial |
$649.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$544.32
|
| Rate for Payer: Cash Price |
$464.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$643.11
|
| Rate for Payer: Cigna of WY Commercial |
$649.74
|
| Rate for Payer: Entrust Commercial |
$629.85
|
| Rate for Payer: First Choice Health Commercial |
$629.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$629.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.58
|
| Rate for Payer: HealthUtah PPO |
$663.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$643.11
|
| Rate for Payer: Multiplan Medicare/VA |
$415.70
|
| Rate for Payer: One Health Plan of WY PPO |
$649.74
|
| Rate for Payer: PacificSource Commercial |
$596.70
|
| Rate for Payer: PHCS PPO |
$649.74
|
| Rate for Payer: Three Rivers PPO |
$497.25
|
| Rate for Payer: TriWest Veterans Administration |
$437.58
|
| Rate for Payer: United Healthcare Commercial |
$576.81
|
| Rate for Payer: United Healthcare Medicare |
$437.58
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
| Rate for Payer: Wise Provider Network Commercial |
$629.85
|
|
|
HC REMOVAL FB MUSCLE/TENDON SHEATH DEEP/COMPLICATED
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
7612052501
|
|
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 REMOVAL FB MUSCLE/TENDON SHEATH DEEP/COMPLICATED
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
7612052501
|
|
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 REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
5103031001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
5103031001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.10
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$79.90
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.10
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$84.10
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5103030001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
5103030001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
5102052001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
5102052001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
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 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
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 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
5102070501
|
|
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
|
|
