|
HC REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 20705
|
| Hospital Charge Code |
5102070501
|
|
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 REMOVAL OF NAIL BED
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
7611175001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.93 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Altius Commercial |
$566.40
|
| Rate for Payer: Beech Street Commercial |
$578.20
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: Entrust Commercial |
$560.50
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Multiplan Medicare/VA |
$369.93
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: PHCS PPO |
$578.20
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: TriWest Veterans Administration |
$389.40
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$389.40
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: WINHealth Partners Commercial |
$560.50
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
|
HC REMOVAL OF NAIL BED
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
7611175001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.09 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$389.40
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$566.40
|
| Rate for Payer: Altius Commercial |
$566.40
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Beech Street Commercial |
$578.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$484.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: Entrust Commercial |
$560.50
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$342.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Multiplan Medicare/VA |
$325.09
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: PHCS PPO |
$578.20
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: TriWest Veterans Administration |
$342.20
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$342.20
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: WINHealth Partners Commercial |
$578.20
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$560.50
|
|
|
HC REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
7611173001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
7611173001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC REMOVAL OF SKIN TAGS, UP TO 15
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
5101120001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.52
|
| Rate for Payer: Aetna of WY Medicare |
$48.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.04
|
| Rate for Payer: Altius Commercial |
$71.04
|
| Rate for Payer: Beech Street Commercial |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.75
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.78
|
| Rate for Payer: Cigna of WY Commercial |
$72.52
|
| Rate for Payer: Entrust Commercial |
$70.30
|
| Rate for Payer: First Choice Health Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.92
|
| Rate for Payer: HealthUtah PPO |
$74.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.78
|
| Rate for Payer: Multiplan Medicare/VA |
$40.77
|
| Rate for Payer: One Health Plan of WY PPO |
$72.52
|
| Rate for Payer: PacificSource Commercial |
$66.60
|
| Rate for Payer: PHCS PPO |
$72.52
|
| Rate for Payer: Three Rivers PPO |
$55.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.92
|
| Rate for Payer: United Healthcare Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare |
$42.92
|
| Rate for Payer: WINHealth Partners Commercial |
$72.52
|
| Rate for Payer: Wise Provider Network Commercial |
$70.30
|
|
|
HC REMOVAL OF SKIN TAGS, UP TO 15
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
5101120001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.04
|
| Rate for Payer: Altius Commercial |
$71.04
|
| Rate for Payer: Beech Street Commercial |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.75
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.78
|
| Rate for Payer: Cigna of WY Commercial |
$72.52
|
| Rate for Payer: Entrust Commercial |
$70.30
|
| Rate for Payer: First Choice Health Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.84
|
| Rate for Payer: HealthUtah PPO |
$74.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.78
|
| Rate for Payer: Multiplan Medicare/VA |
$46.40
|
| Rate for Payer: One Health Plan of WY PPO |
$72.52
|
| Rate for Payer: PacificSource Commercial |
$66.60
|
| Rate for Payer: PHCS PPO |
$72.52
|
| Rate for Payer: Three Rivers PPO |
$55.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.84
|
| Rate for Payer: United Healthcare Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare |
$48.84
|
| Rate for Payer: WINHealth Partners Commercial |
$70.30
|
| Rate for Payer: Wise Provider Network Commercial |
$70.30
|
|
|
HC REMOVAL SUPERFICIAL IMPLANT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
5102067001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.10 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.42
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$82.10
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.42
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$86.42
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC REMOVAL SUPERFICIAL IMPLANT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
5102067001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.34
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$93.42
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.34
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
5101585301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
5101585301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
5103659001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.26
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$108.55
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$114.26
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
5103659001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.02
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.52
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.02
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$130.02
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
7612524801
|
|
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 REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
7612524801
|
|
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 REMOVE FOREIGN BODY COMPLIC
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
7611012101
|
|
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 REMOVE FOREIGN BODY COMPLIC
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
7611012101
|
|
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 REMOVE FOREIGN BODY SIMPLE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
5101012001
|
|
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 REMOVE FOREIGN BODY SIMPLE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7611012001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| 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) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$55.18
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.08
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: United Healthcare Medicare |
$58.08
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: WINHealth Partners Commercial |
$83.60
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
5101012001
|
|
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 REMOVE FOREIGN BODY SIMPLE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7611012001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$58.08
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$48.49
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.04
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Medicare |
$51.04
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: WINHealth Partners Commercial |
$86.24
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
|
|
HC REMOVE INTRAUTERINE DEVICE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
7615830101
|
|
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 REMOVE INTRAUTERINE DEVICE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
7615830101
|
|
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 REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
7613030001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
7613030001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
