|
HC SHAVE SKIN LESION 0.6-1.0 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
5101130101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
| Rate for Payer: Altius Commercial |
$49.92
|
| Rate for Payer: Beech Street Commercial |
$50.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: Entrust Commercial |
$49.40
|
| Rate for Payer: First Choice Health Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.32
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$50.96
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.32
|
| Rate for Payer: United Healthcare Commercial |
$45.24
|
| Rate for Payer: United Healthcare Medicare |
$34.32
|
| Rate for Payer: WINHealth Partners Commercial |
$49.40
|
| Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
|
HC SHAVE SKIN LESION 0.6-1.0 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
5101130101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Aetna of WY Medicare |
$34.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.92
|
| Rate for Payer: Altius Commercial |
$49.92
|
| Rate for Payer: Beech Street Commercial |
$50.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.69
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: Entrust Commercial |
$49.40
|
| Rate for Payer: First Choice Health Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.16
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: Multiplan Medicare/VA |
$28.65
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$50.96
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: TriWest Veterans Administration |
$30.16
|
| Rate for Payer: United Healthcare Commercial |
$45.24
|
| Rate for Payer: United Healthcare Medicare |
$30.16
|
| Rate for Payer: WINHealth Partners Commercial |
$50.96
|
| Rate for Payer: Wise Provider Network Commercial |
$49.40
|
|
|
HC SHAVING SKIN LESION 0.06 -1.0 CM FACE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
5101131101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Aetna of WY Medicare |
$42.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.44
|
| Rate for Payer: Altius Commercial |
$61.44
|
| Rate for Payer: Beech Street Commercial |
$62.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.54
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: Entrust Commercial |
$60.80
|
| Rate for Payer: First Choice Health Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: Multiplan Medicare/VA |
$35.26
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$62.72
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: WINHealth Partners Commercial |
$62.72
|
| Rate for Payer: Wise Provider Network Commercial |
$60.80
|
|
|
HC SHAVING SKIN LESION 0.06 -1.0 CM FACE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
5101131101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.44
|
| Rate for Payer: Altius Commercial |
$61.44
|
| Rate for Payer: Beech Street Commercial |
$62.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.54
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
| Rate for Payer: Cigna of WY Commercial |
$62.72
|
| Rate for Payer: Entrust Commercial |
$60.80
|
| Rate for Payer: First Choice Health Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.24
|
| Rate for Payer: HealthUtah PPO |
$64.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
| Rate for Payer: Multiplan Medicare/VA |
$40.13
|
| Rate for Payer: One Health Plan of WY PPO |
$62.72
|
| Rate for Payer: PacificSource Commercial |
$57.60
|
| Rate for Payer: PHCS PPO |
$62.72
|
| Rate for Payer: Three Rivers PPO |
$48.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.24
|
| Rate for Payer: United Healthcare Commercial |
$55.68
|
| Rate for Payer: United Healthcare Medicare |
$42.24
|
| Rate for Payer: WINHealth Partners Commercial |
$60.80
|
| Rate for Payer: Wise Provider Network Commercial |
$60.80
|
|
|
HC SHAVING SKIN LESION <0.5 CM FACE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
5101131001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.12
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.26
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$25.90
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.26
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: United Healthcare Medicare |
$27.26
|
| Rate for Payer: WINHealth Partners Commercial |
$46.06
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC SHAVING SKIN LESION <0.5 CM FACE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
5101131001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.12
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.02
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$29.47
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: United Healthcare Medicare |
$31.02
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
HC SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
5101131301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$52.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$75.84
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.82
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$43.53
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$45.82
|
| Rate for Payer: United Healthcare Commercial |
$68.73
|
| Rate for Payer: United Healthcare Medicare |
$45.82
|
| Rate for Payer: WINHealth Partners Commercial |
$77.42
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
5101131301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.53 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$75.84
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.14
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$49.53
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$52.14
|
| Rate for Payer: United Healthcare Commercial |
$68.73
|
| Rate for Payer: United Healthcare Medicare |
$52.14
|
| Rate for Payer: WINHealth Partners Commercial |
$75.05
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
5101130501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
5101130501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.62
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
5101130701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Aetna of WY Medicare |
$42.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.70
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$35.82
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.70
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$37.70
|
| Rate for Payer: WINHealth Partners Commercial |
$63.70
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
5101130701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.40
|
| Rate for Payer: Altius Commercial |
$62.40
|
| Rate for Payer: Beech Street Commercial |
$63.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.36
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$63.05
|
| Rate for Payer: Cigna of WY Commercial |
$63.70
|
| Rate for Payer: Entrust Commercial |
$61.75
|
| Rate for Payer: First Choice Health Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.90
|
| Rate for Payer: HealthUtah PPO |
$65.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$63.05
|
| Rate for Payer: Multiplan Medicare/VA |
$40.76
|
| Rate for Payer: One Health Plan of WY PPO |
$63.70
|
| Rate for Payer: PacificSource Commercial |
$58.50
|
| Rate for Payer: PHCS PPO |
$63.70
|
| Rate for Payer: Three Rivers PPO |
$48.75
|
| Rate for Payer: TriWest Veterans Administration |
$42.90
|
| Rate for Payer: United Healthcare Commercial |
$56.55
|
| Rate for Payer: United Healthcare Medicare |
$42.90
|
| Rate for Payer: WINHealth Partners Commercial |
$61.75
|
| Rate for Payer: Wise Provider Network Commercial |
$61.75
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
5101130801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.52
|
| Rate for Payer: Aetna of WY Medicare |
$48.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.04
|
| Rate for Payer: Altius Commercial |
$71.04
|
| Rate for Payer: Beech Street Commercial |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.75
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.78
|
| Rate for Payer: Cigna of WY Commercial |
$72.52
|
| Rate for Payer: Entrust Commercial |
$70.30
|
| Rate for Payer: First Choice Health Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.92
|
| Rate for Payer: HealthUtah PPO |
$74.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.78
|
| Rate for Payer: Multiplan Medicare/VA |
$40.77
|
| Rate for Payer: One Health Plan of WY PPO |
$72.52
|
| Rate for Payer: PacificSource Commercial |
$66.60
|
| Rate for Payer: PHCS PPO |
$72.52
|
| Rate for Payer: Three Rivers PPO |
$55.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.92
|
| Rate for Payer: United Healthcare Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare |
$42.92
|
| Rate for Payer: WINHealth Partners Commercial |
$72.52
|
| Rate for Payer: Wise Provider Network Commercial |
$70.30
|
|
|
HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
5101130801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.04
|
| Rate for Payer: Altius Commercial |
$71.04
|
| Rate for Payer: Beech Street Commercial |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.75
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.78
|
| Rate for Payer: Cigna of WY Commercial |
$72.52
|
| Rate for Payer: Entrust Commercial |
$70.30
|
| Rate for Payer: First Choice Health Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.84
|
| Rate for Payer: HealthUtah PPO |
$74.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.78
|
| Rate for Payer: Multiplan Medicare/VA |
$46.40
|
| Rate for Payer: One Health Plan of WY PPO |
$72.52
|
| Rate for Payer: PacificSource Commercial |
$66.60
|
| Rate for Payer: PHCS PPO |
$72.52
|
| Rate for Payer: Three Rivers PPO |
$55.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.84
|
| Rate for Payer: United Healthcare Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare |
$48.84
|
| Rate for Payer: WINHealth Partners Commercial |
$70.30
|
| Rate for Payer: Wise Provider Network Commercial |
$70.30
|
|
|
HC SHORT-LATENCY SOMATOSENS EP STD U& LOW LIMB
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 95938
|
| Hospital Charge Code |
9229593801
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$936.70 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,122.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,632.00
|
| Rate for Payer: Altius Commercial |
$1,632.00
|
| Rate for Payer: Beech Street Commercial |
$1,666.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.70
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.00
|
| Rate for Payer: Entrust Commercial |
$1,615.00
|
| Rate for Payer: First Choice Health Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$986.00
|
| Rate for Payer: HealthUtah PPO |
$1,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.00
|
| Rate for Payer: Multiplan Medicare/VA |
$936.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.00
|
| Rate for Payer: PacificSource Commercial |
$1,530.00
|
| Rate for Payer: PHCS PPO |
$1,666.00
|
| Rate for Payer: Three Rivers PPO |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$986.00
|
| Rate for Payer: United Healthcare Commercial |
$1,479.00
|
| Rate for Payer: United Healthcare Medicare |
$986.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,666.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,615.00
|
|
|
HC SHORT-LATENCY SOMATOSENS EP STD U& LOW LIMB
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 95938
|
| Hospital Charge Code |
9229593801
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,065.90 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,666.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,632.00
|
| Rate for Payer: Altius Commercial |
$1,632.00
|
| Rate for Payer: Beech Street Commercial |
$1,666.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,395.70
|
| Rate for Payer: Cash Price |
$1,190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,649.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,666.00
|
| Rate for Payer: Entrust Commercial |
$1,615.00
|
| Rate for Payer: First Choice Health Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,615.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,122.00
|
| Rate for Payer: HealthUtah PPO |
$1,700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,649.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,065.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,666.00
|
| Rate for Payer: PacificSource Commercial |
$1,530.00
|
| Rate for Payer: PHCS PPO |
$1,666.00
|
| Rate for Payer: Three Rivers PPO |
$1,275.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,122.00
|
| Rate for Payer: United Healthcare Commercial |
$1,479.00
|
| Rate for Payer: United Healthcare Medicare |
$1,122.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,615.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,615.00
|
|
|
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
5101131201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Aetna of WY Medicare |
$50.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.08
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$41.88
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.08
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$44.08
|
| Rate for Payer: WINHealth Partners Commercial |
$74.48
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
5101131201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.65 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.16
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$47.65
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$50.16
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$50.16
|
| Rate for Payer: WINHealth Partners Commercial |
$72.20
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
5101130301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Aetna of WY Medicare |
$47.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$69.12
|
| Rate for Payer: Altius Commercial |
$69.12
|
| Rate for Payer: Beech Street Commercial |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.11
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: Entrust Commercial |
$68.40
|
| Rate for Payer: First Choice Health Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.76
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$39.67
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$70.56
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$41.76
|
| Rate for Payer: United Healthcare Commercial |
$62.64
|
| Rate for Payer: United Healthcare Medicare |
$41.76
|
| Rate for Payer: WINHealth Partners Commercial |
$70.56
|
| Rate for Payer: Wise Provider Network Commercial |
$68.40
|
|
|
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
5101130301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$69.12
|
| Rate for Payer: Altius Commercial |
$69.12
|
| Rate for Payer: Beech Street Commercial |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.11
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: Entrust Commercial |
$68.40
|
| Rate for Payer: First Choice Health Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.52
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$45.14
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$70.56
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.52
|
| Rate for Payer: United Healthcare Commercial |
$62.64
|
| Rate for Payer: United Healthcare Medicare |
$47.52
|
| Rate for Payer: WINHealth Partners Commercial |
$68.40
|
| Rate for Payer: Wise Provider Network Commercial |
$68.40
|
|
|
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
5101130201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$40.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.96
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$34.16
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.96
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$35.96
|
| Rate for Payer: WINHealth Partners Commercial |
$60.76
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
5101130201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.92
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$38.87
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.92
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$40.92
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
5105172501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.24
|
| Rate for Payer: Aetna of WY Medicare |
$91.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$132.48
|
| Rate for Payer: Altius Commercial |
$132.48
|
| Rate for Payer: Beech Street Commercial |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.30
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.86
|
| Rate for Payer: Cigna of WY Commercial |
$135.24
|
| Rate for Payer: Entrust Commercial |
$131.10
|
| Rate for Payer: First Choice Health Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.04
|
| Rate for Payer: HealthUtah PPO |
$138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.86
|
| Rate for Payer: Multiplan Medicare/VA |
$76.04
|
| Rate for Payer: One Health Plan of WY PPO |
$135.24
|
| Rate for Payer: PacificSource Commercial |
$124.20
|
| Rate for Payer: PHCS PPO |
$135.24
|
| Rate for Payer: Three Rivers PPO |
$103.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.04
|
| Rate for Payer: United Healthcare Commercial |
$120.06
|
| Rate for Payer: United Healthcare Medicare |
$80.04
|
| Rate for Payer: WINHealth Partners Commercial |
$135.24
|
| Rate for Payer: Wise Provider Network Commercial |
$131.10
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
5105172501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.53 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$132.48
|
| Rate for Payer: Altius Commercial |
$132.48
|
| Rate for Payer: Beech Street Commercial |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.30
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.86
|
| Rate for Payer: Cigna of WY Commercial |
$135.24
|
| Rate for Payer: Entrust Commercial |
$131.10
|
| Rate for Payer: First Choice Health Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.08
|
| Rate for Payer: HealthUtah PPO |
$138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.86
|
| Rate for Payer: Multiplan Medicare/VA |
$86.53
|
| Rate for Payer: One Health Plan of WY PPO |
$135.24
|
| Rate for Payer: PacificSource Commercial |
$124.20
|
| Rate for Payer: PHCS PPO |
$135.24
|
| Rate for Payer: Three Rivers PPO |
$103.50
|
| Rate for Payer: TriWest Veterans Administration |
$91.08
|
| Rate for Payer: United Healthcare Commercial |
$120.06
|
| Rate for Payer: United Healthcare Medicare |
$91.08
|
| Rate for Payer: WINHealth Partners Commercial |
$131.10
|
| Rate for Payer: Wise Provider Network Commercial |
$131.10
|
|
|
HC SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
5101201401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Aetna of WY Medicare |
$50.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.08
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$41.88
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.08
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$44.08
|
| Rate for Payer: WINHealth Partners Commercial |
$74.48
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
