|
HC RESUPERF WND BODY 12.6-20 CM
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
7611200501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.50 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.04
|
| Rate for Payer: Aetna of WY Medicare |
$394.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$574.08
|
| Rate for Payer: Altius Commercial |
$574.08
|
| Rate for Payer: Beech Street Commercial |
$586.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$490.96
|
| Rate for Payer: Cash Price |
$418.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.06
|
| Rate for Payer: Cigna of WY Commercial |
$586.04
|
| Rate for Payer: Entrust Commercial |
$568.10
|
| Rate for Payer: First Choice Health Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.84
|
| Rate for Payer: HealthUtah PPO |
$598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.06
|
| Rate for Payer: Multiplan Medicare/VA |
$329.50
|
| Rate for Payer: One Health Plan of WY PPO |
$586.04
|
| Rate for Payer: PacificSource Commercial |
$538.20
|
| Rate for Payer: PHCS PPO |
$586.04
|
| Rate for Payer: Three Rivers PPO |
$448.50
|
| Rate for Payer: TriWest Veterans Administration |
$346.84
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$346.84
|
| Rate for Payer: WINHealth Partners Commercial |
$586.04
|
| Rate for Payer: Wise Provider Network Commercial |
$568.10
|
|
|
HC RESUPERF WND BODY 12.6-20 CM
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
7611200501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.95 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$574.08
|
| Rate for Payer: Altius Commercial |
$574.08
|
| Rate for Payer: Beech Street Commercial |
$586.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$490.96
|
| Rate for Payer: Cash Price |
$418.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.06
|
| Rate for Payer: Cigna of WY Commercial |
$586.04
|
| Rate for Payer: Entrust Commercial |
$568.10
|
| Rate for Payer: First Choice Health Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.68
|
| Rate for Payer: HealthUtah PPO |
$598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.06
|
| Rate for Payer: Multiplan Medicare/VA |
$374.95
|
| Rate for Payer: One Health Plan of WY PPO |
$586.04
|
| Rate for Payer: PacificSource Commercial |
$538.20
|
| Rate for Payer: PHCS PPO |
$586.04
|
| Rate for Payer: Three Rivers PPO |
$448.50
|
| Rate for Payer: TriWest Veterans Administration |
$394.68
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$394.68
|
| Rate for Payer: WINHealth Partners Commercial |
$568.10
|
| Rate for Payer: Wise Provider Network Commercial |
$568.10
|
|
|
HC RESUPERF WND BODY 20.1-30 CM
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
7611200601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.87 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$458.64
|
| Rate for Payer: Aetna of WY Medicare |
$308.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$449.28
|
| Rate for Payer: Altius Commercial |
$449.28
|
| Rate for Payer: Beech Street Commercial |
$458.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$384.23
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$453.96
|
| Rate for Payer: Cigna of WY Commercial |
$458.64
|
| Rate for Payer: Entrust Commercial |
$444.60
|
| Rate for Payer: First Choice Health Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$271.44
|
| Rate for Payer: HealthUtah PPO |
$468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$453.96
|
| Rate for Payer: Multiplan Medicare/VA |
$257.87
|
| Rate for Payer: One Health Plan of WY PPO |
$458.64
|
| Rate for Payer: PacificSource Commercial |
$421.20
|
| Rate for Payer: PHCS PPO |
$458.64
|
| Rate for Payer: Three Rivers PPO |
$351.00
|
| Rate for Payer: TriWest Veterans Administration |
$271.44
|
| Rate for Payer: United Healthcare Commercial |
$407.16
|
| Rate for Payer: United Healthcare Medicare |
$271.44
|
| Rate for Payer: WINHealth Partners Commercial |
$458.64
|
| Rate for Payer: Wise Provider Network Commercial |
$444.60
|
|
|
HC RESUPERF WND BODY 20.1-30 CM
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
7611200601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$458.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$449.28
|
| Rate for Payer: Altius Commercial |
$449.28
|
| Rate for Payer: Beech Street Commercial |
$458.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$384.23
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$453.96
|
| Rate for Payer: Cigna of WY Commercial |
$458.64
|
| Rate for Payer: Entrust Commercial |
$444.60
|
| Rate for Payer: First Choice Health Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.88
|
| Rate for Payer: HealthUtah PPO |
$468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$453.96
|
| Rate for Payer: Multiplan Medicare/VA |
$293.44
|
| Rate for Payer: One Health Plan of WY PPO |
$458.64
|
| Rate for Payer: PacificSource Commercial |
$421.20
|
| Rate for Payer: PHCS PPO |
$458.64
|
| Rate for Payer: Three Rivers PPO |
$351.00
|
| Rate for Payer: TriWest Veterans Administration |
$308.88
|
| Rate for Payer: United Healthcare Commercial |
$407.16
|
| Rate for Payer: United Healthcare Medicare |
$308.88
|
| Rate for Payer: WINHealth Partners Commercial |
$444.60
|
| Rate for Payer: Wise Provider Network Commercial |
$444.60
|
|
|
HC RESUPERF WND BODY <2.5CM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
7611200101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Aetna of WY Medicare |
$216.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.24
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$180.73
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.24
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$190.24
|
| Rate for Payer: WINHealth Partners Commercial |
$321.44
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC RESUPERF WND BODY <2.5CM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
7611200101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.48
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$205.66
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$216.48
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$216.48
|
| Rate for Payer: WINHealth Partners Commercial |
$311.60
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC RESUPERF WND BODY >30 CM
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
7611200701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.11 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$501.76
|
| Rate for Payer: Aetna of WY Medicare |
$337.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$491.52
|
| Rate for Payer: Altius Commercial |
$491.52
|
| Rate for Payer: Beech Street Commercial |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.35
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$496.64
|
| Rate for Payer: Cigna of WY Commercial |
$501.76
|
| Rate for Payer: Entrust Commercial |
$486.40
|
| Rate for Payer: First Choice Health Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$296.96
|
| Rate for Payer: HealthUtah PPO |
$512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$496.64
|
| Rate for Payer: Multiplan Medicare/VA |
$282.11
|
| Rate for Payer: One Health Plan of WY PPO |
$501.76
|
| Rate for Payer: PacificSource Commercial |
$460.80
|
| Rate for Payer: PHCS PPO |
$501.76
|
| Rate for Payer: Three Rivers PPO |
$384.00
|
| Rate for Payer: TriWest Veterans Administration |
$296.96
|
| Rate for Payer: United Healthcare Commercial |
$445.44
|
| Rate for Payer: United Healthcare Medicare |
$296.96
|
| Rate for Payer: WINHealth Partners Commercial |
$501.76
|
| Rate for Payer: Wise Provider Network Commercial |
$486.40
|
|
|
HC RESUPERF WND BODY >30 CM
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
7611200701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.02 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$501.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$491.52
|
| Rate for Payer: Altius Commercial |
$491.52
|
| Rate for Payer: Beech Street Commercial |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.35
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$496.64
|
| Rate for Payer: Cigna of WY Commercial |
$501.76
|
| Rate for Payer: Entrust Commercial |
$486.40
|
| Rate for Payer: First Choice Health Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.92
|
| Rate for Payer: HealthUtah PPO |
$512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$496.64
|
| Rate for Payer: Multiplan Medicare/VA |
$321.02
|
| Rate for Payer: One Health Plan of WY PPO |
$501.76
|
| Rate for Payer: PacificSource Commercial |
$460.80
|
| Rate for Payer: PHCS PPO |
$501.76
|
| Rate for Payer: Three Rivers PPO |
$384.00
|
| Rate for Payer: TriWest Veterans Administration |
$337.92
|
| Rate for Payer: United Healthcare Commercial |
$445.44
|
| Rate for Payer: United Healthcare Medicare |
$337.92
|
| Rate for Payer: WINHealth Partners Commercial |
$486.40
|
| Rate for Payer: Wise Provider Network Commercial |
$486.40
|
|
|
HC RESUPERF WND BODY 7.6-12.5 CM
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
7611200401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$437.76
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.38
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.48
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$251.26
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.48
|
| Rate for Payer: United Healthcare Commercial |
$396.72
|
| Rate for Payer: United Healthcare Medicare |
$264.48
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC RESUPERF WND BODY 7.6-12.5 CM
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
7611200401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.91 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$437.76
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.38
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.96
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$285.91
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$300.96
|
| Rate for Payer: United Healthcare Commercial |
$396.72
|
| Rate for Payer: United Healthcare Medicare |
$300.96
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC RESUPERF WND FACE 12.6-20 CM
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
7611201601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.95 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$574.08
|
| Rate for Payer: Altius Commercial |
$574.08
|
| Rate for Payer: Beech Street Commercial |
$586.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$490.96
|
| Rate for Payer: Cash Price |
$418.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.06
|
| Rate for Payer: Cigna of WY Commercial |
$586.04
|
| Rate for Payer: Entrust Commercial |
$568.10
|
| Rate for Payer: First Choice Health Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$394.68
|
| Rate for Payer: HealthUtah PPO |
$598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.06
|
| Rate for Payer: Multiplan Medicare/VA |
$374.95
|
| Rate for Payer: One Health Plan of WY PPO |
$586.04
|
| Rate for Payer: PacificSource Commercial |
$538.20
|
| Rate for Payer: PHCS PPO |
$586.04
|
| Rate for Payer: Three Rivers PPO |
$448.50
|
| Rate for Payer: TriWest Veterans Administration |
$394.68
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$394.68
|
| Rate for Payer: WINHealth Partners Commercial |
$568.10
|
| Rate for Payer: Wise Provider Network Commercial |
$568.10
|
|
|
HC RESUPERF WND FACE 12.6-20 CM
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
7611201601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.50 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.04
|
| Rate for Payer: Aetna of WY Medicare |
$394.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$574.08
|
| Rate for Payer: Altius Commercial |
$574.08
|
| Rate for Payer: Beech Street Commercial |
$586.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$490.96
|
| Rate for Payer: Cash Price |
$418.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.06
|
| Rate for Payer: Cigna of WY Commercial |
$586.04
|
| Rate for Payer: Entrust Commercial |
$568.10
|
| Rate for Payer: First Choice Health Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.84
|
| Rate for Payer: HealthUtah PPO |
$598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.06
|
| Rate for Payer: Multiplan Medicare/VA |
$329.50
|
| Rate for Payer: One Health Plan of WY PPO |
$586.04
|
| Rate for Payer: PacificSource Commercial |
$538.20
|
| Rate for Payer: PHCS PPO |
$586.04
|
| Rate for Payer: Three Rivers PPO |
$448.50
|
| Rate for Payer: TriWest Veterans Administration |
$346.84
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$346.84
|
| Rate for Payer: WINHealth Partners Commercial |
$586.04
|
| Rate for Payer: Wise Provider Network Commercial |
$568.10
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
7611201101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Aetna of WY Medicare |
$216.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.24
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$180.73
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$190.24
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$190.24
|
| Rate for Payer: WINHealth Partners Commercial |
$321.44
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
7611201101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$321.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$314.88
|
| Rate for Payer: Altius Commercial |
$314.88
|
| Rate for Payer: Beech Street Commercial |
$321.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$269.29
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$318.16
|
| Rate for Payer: Cigna of WY Commercial |
$321.44
|
| Rate for Payer: Entrust Commercial |
$311.60
|
| Rate for Payer: First Choice Health Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$311.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.48
|
| Rate for Payer: HealthUtah PPO |
$328.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$318.16
|
| Rate for Payer: Multiplan Medicare/VA |
$205.66
|
| Rate for Payer: One Health Plan of WY PPO |
$321.44
|
| Rate for Payer: PacificSource Commercial |
$295.20
|
| Rate for Payer: PHCS PPO |
$321.44
|
| Rate for Payer: Three Rivers PPO |
$246.00
|
| Rate for Payer: TriWest Veterans Administration |
$216.48
|
| Rate for Payer: United Healthcare Commercial |
$285.36
|
| Rate for Payer: United Healthcare Medicare |
$216.48
|
| Rate for Payer: WINHealth Partners Commercial |
$311.60
|
| Rate for Payer: Wise Provider Network Commercial |
$311.60
|
|
|
HC RESUPERF WND FACE 2.6-5 CM
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
7611201301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.41 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.38
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$246.41
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$259.38
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$259.38
|
| Rate for Payer: WINHealth Partners Commercial |
$373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RESUPERF WND FACE 2.6-5 CM
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
7611201301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.54 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$259.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.94
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$216.54
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.94
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$227.94
|
| Rate for Payer: WINHealth Partners Commercial |
$385.14
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RESUPERF WND FACE 5.1-7.5 CM
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
7611201401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.41 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.38
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$246.41
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$259.38
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$259.38
|
| Rate for Payer: WINHealth Partners Commercial |
$373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RESUPERF WND FACE 5.1-7.5 CM
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
7611201401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.54 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$259.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.94
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$216.54
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.94
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$227.94
|
| Rate for Payer: WINHealth Partners Commercial |
$385.14
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RESUPERF WND FACE 7.6-12.5 CM
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
7611201501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.91 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$437.76
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.38
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$300.96
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$285.91
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$300.96
|
| Rate for Payer: United Healthcare Commercial |
$396.72
|
| Rate for Payer: United Healthcare Medicare |
$300.96
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC RESUPERF WND FACE 7.6-12.5 CM
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
7611201501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$437.76
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.38
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.48
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$251.26
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.48
|
| Rate for Payer: United Healthcare Commercial |
$396.72
|
| Rate for Payer: United Healthcare Medicare |
$264.48
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC RESUP NPTERF WND BODY 2.6-7.5 CM
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
7611200201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.54 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Aetna of WY Medicare |
$259.38
|
| Rate for Payer: Aetna of WY Medicare |
$924.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,344.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,149.40
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$812.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$216.54
|
| Rate for Payer: Multiplan Medicare/VA |
$771.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.94
|
| Rate for Payer: TriWest Veterans Administration |
$812.00
|
| Rate for Payer: United Healthcare Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$812.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,372.00
|
| Rate for Payer: WINHealth Partners Commercial |
$385.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RESUP NPTERF WND BODY 2.6-7.5 CM
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
7611200201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.41 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,372.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,344.00
|
| Rate for Payer: Altius Commercial |
$1,344.00
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Beech Street Commercial |
$1,372.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,149.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,358.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,372.00
|
| Rate for Payer: Entrust Commercial |
$1,330.00
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$1,330.00
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,330.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$924.00
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: HealthUtah PPO |
$1,400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$246.41
|
| Rate for Payer: Multiplan Medicare/VA |
$877.80
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,372.00
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PacificSource Commercial |
$1,260.00
|
| Rate for Payer: PHCS PPO |
$1,372.00
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$1,050.00
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$259.38
|
| Rate for Payer: TriWest Veterans Administration |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$1,218.00
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$259.38
|
| Rate for Payer: United Healthcare Medicare |
$924.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,330.00
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
