|
HC RENAL FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
3018006901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$153.60
|
| Rate for Payer: Altius Commercial |
$153.60
|
| Rate for Payer: Beech Street Commercial |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.20
|
| Rate for Payer: Cigna of WY Commercial |
$156.80
|
| Rate for Payer: Entrust Commercial |
$152.00
|
| Rate for Payer: First Choice Health Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.60
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$100.32
|
| Rate for Payer: One Health Plan of WY PPO |
$156.80
|
| Rate for Payer: PacificSource Commercial |
$144.00
|
| Rate for Payer: PHCS PPO |
$156.80
|
| Rate for Payer: Three Rivers PPO |
$120.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.60
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WINHealth Partners Commercial |
$152.00
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
5101315101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$270.72
|
| Rate for Payer: Altius Commercial |
$270.72
|
| Rate for Payer: Beech Street Commercial |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: Entrust Commercial |
$267.90
|
| Rate for Payer: First Choice Health Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.12
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$176.81
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$276.36
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$186.12
|
| Rate for Payer: United Healthcare Commercial |
$245.34
|
| Rate for Payer: United Healthcare Medicare |
$186.12
|
| Rate for Payer: WINHealth Partners Commercial |
$267.90
|
| Rate for Payer: Wise Provider Network Commercial |
$267.90
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 13151
|
| Hospital Charge Code |
5101315101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.38 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$276.36
|
| Rate for Payer: Aetna of WY Medicare |
$186.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$270.72
|
| Rate for Payer: Altius Commercial |
$270.72
|
| Rate for Payer: Beech Street Commercial |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$273.54
|
| Rate for Payer: Cigna of WY Commercial |
$276.36
|
| Rate for Payer: Entrust Commercial |
$267.90
|
| Rate for Payer: First Choice Health Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.56
|
| Rate for Payer: HealthUtah PPO |
$282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$273.54
|
| Rate for Payer: Multiplan Medicare/VA |
$155.38
|
| Rate for Payer: One Health Plan of WY PPO |
$276.36
|
| Rate for Payer: PacificSource Commercial |
$253.80
|
| Rate for Payer: PHCS PPO |
$276.36
|
| Rate for Payer: Three Rivers PPO |
$211.50
|
| Rate for Payer: TriWest Veterans Administration |
$163.56
|
| Rate for Payer: United Healthcare Commercial |
$245.34
|
| Rate for Payer: United Healthcare Medicare |
$163.56
|
| Rate for Payer: WINHealth Partners Commercial |
$276.36
|
| Rate for Payer: Wise Provider Network Commercial |
$267.90
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
5101315201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
5101315201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
7611313301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.64
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$35.64
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC REPAIR COMPLEX FAC,HAND,GN EA ADD <5CM
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
7611313301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.32
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.75
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$31.32
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
5101313201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.16 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Aetna of WY Medicare |
$202.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.72
|
| Rate for Payer: Altius Commercial |
$294.72
|
| Rate for Payer: Beech Street Commercial |
$300.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.79
|
| Rate for Payer: Cigna of WY Commercial |
$300.86
|
| Rate for Payer: Entrust Commercial |
$291.65
|
| Rate for Payer: First Choice Health Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.06
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$169.16
|
| Rate for Payer: One Health Plan of WY PPO |
$300.86
|
| Rate for Payer: PacificSource Commercial |
$276.30
|
| Rate for Payer: PHCS PPO |
$300.86
|
| Rate for Payer: Three Rivers PPO |
$230.25
|
| Rate for Payer: TriWest Veterans Administration |
$178.06
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$178.06
|
| Rate for Payer: WINHealth Partners Commercial |
$300.86
|
| Rate for Payer: Wise Provider Network Commercial |
$291.65
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
5101313201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.49 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.72
|
| Rate for Payer: Altius Commercial |
$294.72
|
| Rate for Payer: Beech Street Commercial |
$300.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$252.05
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.79
|
| Rate for Payer: Cigna of WY Commercial |
$300.86
|
| Rate for Payer: Entrust Commercial |
$291.65
|
| Rate for Payer: First Choice Health Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.62
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$192.49
|
| Rate for Payer: One Health Plan of WY PPO |
$300.86
|
| Rate for Payer: PacificSource Commercial |
$276.30
|
| Rate for Payer: PHCS PPO |
$300.86
|
| Rate for Payer: Three Rivers PPO |
$230.25
|
| Rate for Payer: TriWest Veterans Administration |
$202.62
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$202.62
|
| Rate for Payer: WINHealth Partners Commercial |
$291.65
|
| Rate for Payer: Wise Provider Network Commercial |
$291.65
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
5101313301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$84.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.88
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.09
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.24
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$70.53
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$74.24
|
| Rate for Payer: United Healthcare Commercial |
$111.36
|
| Rate for Payer: United Healthcare Medicare |
$74.24
|
| Rate for Payer: WINHealth Partners Commercial |
$125.44
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
5101313301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.88
|
| Rate for Payer: Altius Commercial |
$122.88
|
| Rate for Payer: Beech Street Commercial |
$125.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.09
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: Entrust Commercial |
$121.60
|
| Rate for Payer: First Choice Health Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.48
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$80.26
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$125.44
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$84.48
|
| Rate for Payer: United Healthcare Commercial |
$111.36
|
| Rate for Payer: United Healthcare Medicare |
$84.48
|
| Rate for Payer: WINHealth Partners Commercial |
$121.60
|
| Rate for Payer: Wise Provider Network Commercial |
$121.60
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
5101312101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$251.52
|
| Rate for Payer: Altius Commercial |
$251.52
|
| Rate for Payer: Beech Street Commercial |
$256.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.10
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: Entrust Commercial |
$248.90
|
| Rate for Payer: First Choice Health Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.92
|
| Rate for Payer: HealthUtah PPO |
$262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$164.27
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$256.76
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$172.92
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$172.92
|
| Rate for Payer: WINHealth Partners Commercial |
$248.90
|
| Rate for Payer: Wise Provider Network Commercial |
$248.90
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
5101312101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Aetna of WY Medicare |
$172.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$251.52
|
| Rate for Payer: Altius Commercial |
$251.52
|
| Rate for Payer: Beech Street Commercial |
$256.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.10
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: Entrust Commercial |
$248.90
|
| Rate for Payer: First Choice Health Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.96
|
| Rate for Payer: HealthUtah PPO |
$262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$144.36
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$256.76
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.96
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$151.96
|
| Rate for Payer: WINHealth Partners Commercial |
$256.76
|
| Rate for Payer: Wise Provider Network Commercial |
$248.90
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
5101312201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.64
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.96
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.72
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$46.28
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$48.72
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$48.72
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
5101312201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.64
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.96
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.44
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$52.67
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$55.44
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$55.44
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
HC REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
5101310101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.02
|
| Rate for Payer: Aetna of WY Medicare |
$164.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$239.04
|
| Rate for Payer: Altius Commercial |
$239.04
|
| Rate for Payer: Beech Street Commercial |
$244.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.43
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.53
|
| Rate for Payer: Cigna of WY Commercial |
$244.02
|
| Rate for Payer: Entrust Commercial |
$236.55
|
| Rate for Payer: First Choice Health Commercial |
$236.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.42
|
| Rate for Payer: HealthUtah PPO |
$249.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.53
|
| Rate for Payer: Multiplan Medicare/VA |
$137.20
|
| Rate for Payer: One Health Plan of WY PPO |
$244.02
|
| Rate for Payer: PacificSource Commercial |
$224.10
|
| Rate for Payer: PHCS PPO |
$244.02
|
| Rate for Payer: Three Rivers PPO |
$186.75
|
| Rate for Payer: TriWest Veterans Administration |
$144.42
|
| Rate for Payer: United Healthcare Commercial |
$216.63
|
| Rate for Payer: United Healthcare Medicare |
$144.42
|
| Rate for Payer: WINHealth Partners Commercial |
$244.02
|
| Rate for Payer: Wise Provider Network Commercial |
$236.55
|
|
|
HC REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
5101310101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$239.04
|
| Rate for Payer: Altius Commercial |
$239.04
|
| Rate for Payer: Beech Street Commercial |
$244.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.43
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.53
|
| Rate for Payer: Cigna of WY Commercial |
$244.02
|
| Rate for Payer: Entrust Commercial |
$236.55
|
| Rate for Payer: First Choice Health Commercial |
$236.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.34
|
| Rate for Payer: HealthUtah PPO |
$249.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.53
|
| Rate for Payer: Multiplan Medicare/VA |
$156.12
|
| Rate for Payer: One Health Plan of WY PPO |
$244.02
|
| Rate for Payer: PacificSource Commercial |
$224.10
|
| Rate for Payer: PHCS PPO |
$244.02
|
| Rate for Payer: Three Rivers PPO |
$186.75
|
| Rate for Payer: TriWest Veterans Administration |
$164.34
|
| Rate for Payer: United Healthcare Commercial |
$216.63
|
| Rate for Payer: United Healthcare Medicare |
$164.34
|
| Rate for Payer: WINHealth Partners Commercial |
$236.55
|
| Rate for Payer: Wise Provider Network Commercial |
$236.55
|
|
|
HC REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
5101312001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.09 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$223.68
|
| Rate for Payer: Altius Commercial |
$223.68
|
| Rate for Payer: Beech Street Commercial |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.29
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Entrust Commercial |
$221.35
|
| Rate for Payer: First Choice Health Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.78
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$146.09
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$228.34
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$153.78
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$153.78
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
| Rate for Payer: Wise Provider Network Commercial |
$221.35
|
|
|
HC REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
5101312001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$153.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$223.68
|
| Rate for Payer: Altius Commercial |
$223.68
|
| Rate for Payer: Beech Street Commercial |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.29
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: Entrust Commercial |
$221.35
|
| Rate for Payer: First Choice Health Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.14
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$128.38
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$228.34
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$135.14
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$135.14
|
| Rate for Payer: WINHealth Partners Commercial |
$228.34
|
| Rate for Payer: Wise Provider Network Commercial |
$221.35
|
|
|
HC REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
7611312001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Aetna of WY Medicare |
$331.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.74
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$277.15
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.74
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$291.74
|
| Rate for Payer: WINHealth Partners Commercial |
$492.94
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC REPAIR COMPLEX WND SCALP/EXTREMITY 1.1-2.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
7611312001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.98
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$315.38
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.98
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$331.98
|
| Rate for Payer: WINHealth Partners Commercial |
$477.85
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC REPAIR COMPLEX WND TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
7611310001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.98
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$315.38
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$331.98
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$331.98
|
| Rate for Payer: WINHealth Partners Commercial |
$477.85
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC REPAIR COMPLEX WND TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
7611310001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.15 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$492.94
|
| Rate for Payer: Aetna of WY Medicare |
$331.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$482.88
|
| Rate for Payer: Altius Commercial |
$482.88
|
| Rate for Payer: Beech Street Commercial |
$492.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.96
|
| Rate for Payer: Cash Price |
$352.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$487.91
|
| Rate for Payer: Cigna of WY Commercial |
$492.94
|
| Rate for Payer: Entrust Commercial |
$477.85
|
| Rate for Payer: First Choice Health Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$477.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.74
|
| Rate for Payer: HealthUtah PPO |
$503.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$487.91
|
| Rate for Payer: Multiplan Medicare/VA |
$277.15
|
| Rate for Payer: One Health Plan of WY PPO |
$492.94
|
| Rate for Payer: PacificSource Commercial |
$452.70
|
| Rate for Payer: PHCS PPO |
$492.94
|
| Rate for Payer: Three Rivers PPO |
$377.25
|
| Rate for Payer: TriWest Veterans Administration |
$291.74
|
| Rate for Payer: United Healthcare Commercial |
$437.61
|
| Rate for Payer: United Healthcare Medicare |
$291.74
|
| Rate for Payer: WINHealth Partners Commercial |
$492.94
|
| Rate for Payer: Wise Provider Network Commercial |
$477.85
|
|
|
HC REPAIR COMPLEX WND TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
7611310101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.44
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$340.52
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$358.44
|
| Rate for Payer: WINHealth Partners Commercial |
$605.64
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC REPAIR COMPLEX WND TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
7611310101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.88
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$387.49
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.88
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$407.88
|
| Rate for Payer: WINHealth Partners Commercial |
$587.10
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
