|
HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
3058561301
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC SARS-COV-2 ANTIGEN TEST
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
3008781101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.80
|
| Rate for Payer: Aetna of WY Medicare |
$105.60
|
| 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 |
$92.80
|
| Rate for Payer: HealthUtah PPO |
$160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.20
|
| Rate for Payer: Multiplan Medicare/VA |
$88.16
|
| 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 |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$139.20
|
| Rate for Payer: United Healthcare Medicare |
$92.80
|
| Rate for Payer: WINHealth Partners Commercial |
$156.80
|
| Rate for Payer: Wise Provider Network Commercial |
$152.00
|
|
|
HC SARS-COV-2 ANTIGEN TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
3008781101
|
|
Hospital Revenue Code
|
300
|
| 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 SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 99493
|
| Hospital Charge Code |
5109949301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.36
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$60.19
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$63.36
|
| Rate for Payer: WINHealth Partners Commercial |
$91.20
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 99493
|
| Hospital Charge Code |
5109949301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.68
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$52.90
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$55.68
|
| Rate for Payer: WINHealth Partners Commercial |
$94.08
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$125.31
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING LEFT
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706702
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$125.31
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING LEFT
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706702
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING RIGHT
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706703
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Aetna of WY Medicare |
$422.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.20
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$352.64
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$371.20
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$125.31
|
| Rate for Payer: WINHealth Partners Commercial |
$627.20
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING RIGHT
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
4037706703
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$627.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$614.40
|
| Rate for Payer: Altius Commercial |
$614.40
|
| Rate for Payer: Beech Street Commercial |
$627.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$525.44
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$620.80
|
| Rate for Payer: Cigna of WY Commercial |
$627.20
|
| Rate for Payer: Entrust Commercial |
$608.00
|
| Rate for Payer: First Choice Health Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$608.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$422.40
|
| Rate for Payer: HealthUtah PPO |
$640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$620.80
|
| Rate for Payer: Multiplan Medicare/VA |
$401.28
|
| Rate for Payer: One Health Plan of WY PPO |
$627.20
|
| Rate for Payer: PacificSource Commercial |
$576.00
|
| Rate for Payer: PHCS PPO |
$627.20
|
| Rate for Payer: Three Rivers PPO |
$480.00
|
| Rate for Payer: TriWest Veterans Administration |
$422.40
|
| Rate for Payer: United Healthcare Commercial |
$556.80
|
| Rate for Payer: United Healthcare Medicare |
$422.40
|
| Rate for Payer: WINHealth Partners Commercial |
$608.00
|
| Rate for Payer: Wise Provider Network Commercial |
$608.00
|
|
|
HC SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
5101316001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$341.62 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
| Rate for Payer: Aetna of WY Medicare |
$409.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$595.20
|
| Rate for Payer: Altius Commercial |
$595.20
|
| Rate for Payer: Beech Street Commercial |
$607.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.02
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
| Rate for Payer: Cigna of WY Commercial |
$607.60
|
| Rate for Payer: Entrust Commercial |
$589.00
|
| Rate for Payer: First Choice Health Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.60
|
| Rate for Payer: HealthUtah PPO |
$620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
| Rate for Payer: Multiplan Medicare/VA |
$341.62
|
| Rate for Payer: One Health Plan of WY PPO |
$607.60
|
| Rate for Payer: PacificSource Commercial |
$558.00
|
| Rate for Payer: PHCS PPO |
$607.60
|
| Rate for Payer: Three Rivers PPO |
$465.00
|
| Rate for Payer: TriWest Veterans Administration |
$359.60
|
| Rate for Payer: United Healthcare Commercial |
$539.40
|
| Rate for Payer: United Healthcare Medicare |
$359.60
|
| Rate for Payer: WINHealth Partners Commercial |
$607.60
|
| Rate for Payer: Wise Provider Network Commercial |
$589.00
|
|
|
HC SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
5101316001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$388.74 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$595.20
|
| Rate for Payer: Altius Commercial |
$595.20
|
| Rate for Payer: Beech Street Commercial |
$607.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.02
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.40
|
| Rate for Payer: Cigna of WY Commercial |
$607.60
|
| Rate for Payer: Entrust Commercial |
$589.00
|
| Rate for Payer: First Choice Health Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$409.20
|
| Rate for Payer: HealthUtah PPO |
$620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.40
|
| Rate for Payer: Multiplan Medicare/VA |
$388.74
|
| Rate for Payer: One Health Plan of WY PPO |
$607.60
|
| Rate for Payer: PacificSource Commercial |
$558.00
|
| Rate for Payer: PHCS PPO |
$607.60
|
| Rate for Payer: Three Rivers PPO |
$465.00
|
| Rate for Payer: TriWest Veterans Administration |
$409.20
|
| Rate for Payer: United Healthcare Commercial |
$539.40
|
| Rate for Payer: United Healthcare Medicare |
$409.20
|
| Rate for Payer: WINHealth Partners Commercial |
$589.00
|
| Rate for Payer: Wise Provider Network Commercial |
$589.00
|
|
|
HC SEMEN ANALYSIS POST VASECTOMY
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
3008932101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.90
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$103.46
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$108.90
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC SEMEN ANALYSIS POST VASECTOMY
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
3008932101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$108.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$158.40
|
| Rate for Payer: Altius Commercial |
$158.40
|
| Rate for Payer: Beech Street Commercial |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$135.46
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: Entrust Commercial |
$156.75
|
| Rate for Payer: First Choice Health Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$161.70
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$161.70
|
| Rate for Payer: Wise Provider Network Commercial |
$156.75
|
|
|
HC SEMEN ANALYSIS,VOLUME, COUNT, MOTILITY, DIFF - SEMEN ANALYSIS
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 89320
|
| Hospital Charge Code |
3008932001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC SEMEN ANALYSIS,VOLUME, COUNT, MOTILITY, DIFF - SEMEN ANALYSIS
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 89320
|
| Hospital Charge Code |
3008932001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC SEVOFLUVANE ULTANE 15 MN
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
3700000006
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC SEVOFLUVANE ULTANE 15 MN
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
3700000006
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC SHAVE SKIN LESION <0.5 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
5101130001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Aetna of WY Medicare |
$22.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.72
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$18.73
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.72
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$19.72
|
| Rate for Payer: WINHealth Partners Commercial |
$33.32
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC SHAVE SKIN LESION <0.5 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
5101130001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.44
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$21.32
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.44
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$22.44
|
| Rate for Payer: WINHealth Partners Commercial |
$32.30
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC SHAVE SKIN LESION 0.6-1.0 CM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
5101130601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
HC SHAVE SKIN LESION 0.6-1.0 CM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
5101130601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.66
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$31.98
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$33.66
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
