|
HC TRANSPORT PORTABLE X-RAY ONE PT
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS R0070
|
| Hospital Charge Code |
329R007001
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC TRAUMA RESPONSE LEVEL 1
|
Facility
|
OP
|
$4,963.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
681G039001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,734.61 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,282.60
|
| Rate for Payer: Aetna of WY Medicare |
$3,275.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,884.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,195.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,764.48
|
| Rate for Payer: Altius Commercial |
$4,764.48
|
| Rate for Payer: Altius Commercial |
$4,195.20
|
| Rate for Payer: Beech Street Commercial |
$4,282.60
|
| Rate for Payer: Beech Street Commercial |
$4,863.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,587.77
|
| Rate for Payer: Cash Price |
$3,059.00
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,238.90
|
| Rate for Payer: Cigna of WY Commercial |
$4,282.60
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: Entrust Commercial |
$4,714.85
|
| Rate for Payer: Entrust Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,151.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,878.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,534.60
|
| Rate for Payer: HealthUtah PPO |
$4,370.00
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,238.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$2,734.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2,407.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,282.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PacificSource Commercial |
$3,933.00
|
| Rate for Payer: PHCS PPO |
$4,282.60
|
| Rate for Payer: PHCS PPO |
$4,863.74
|
| Rate for Payer: Three Rivers PPO |
$3,277.50
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,878.54
|
| Rate for Payer: TriWest Veterans Administration |
$2,534.60
|
| Rate for Payer: United Healthcare Commercial |
$3,801.90
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$2,878.54
|
| Rate for Payer: United Healthcare Medicare |
$2,534.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,282.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,863.74
|
| Rate for Payer: Wise Provider Network Commercial |
$4,151.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,714.85
|
|
|
HC TRAUMA RESPONSE LEVEL 1
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
681G039001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,111.80 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,282.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,764.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,195.20
|
| Rate for Payer: Altius Commercial |
$4,195.20
|
| Rate for Payer: Altius Commercial |
$4,764.48
|
| Rate for Payer: Beech Street Commercial |
$4,863.74
|
| Rate for Payer: Beech Street Commercial |
$4,282.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,587.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.62
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: Cash Price |
$3,059.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,238.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: Cigna of WY Commercial |
$4,282.60
|
| Rate for Payer: Entrust Commercial |
$4,151.50
|
| Rate for Payer: Entrust Commercial |
$4,714.85
|
| Rate for Payer: First Choice Health Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,151.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,275.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,884.20
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: HealthUtah PPO |
$4,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,238.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$3,111.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,739.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: One Health Plan of WY PPO |
$4,282.60
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PacificSource Commercial |
$3,933.00
|
| Rate for Payer: PHCS PPO |
$4,282.60
|
| Rate for Payer: PHCS PPO |
$4,863.74
|
| Rate for Payer: Three Rivers PPO |
$3,277.50
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,275.58
|
| Rate for Payer: TriWest Veterans Administration |
$2,884.20
|
| Rate for Payer: United Healthcare Commercial |
$3,801.90
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$3,275.58
|
| Rate for Payer: United Healthcare Medicare |
$2,884.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,151.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,714.85
|
| Rate for Payer: Wise Provider Network Commercial |
$4,151.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,714.85
|
|
|
HC TRAUMA RESPONSE LEVEL 2
|
Facility
|
OP
|
$4,963.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
682G039001
|
|
Hospital Revenue Code
|
682
|
| Min. Negotiated Rate |
$2,734.61 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,282.60
|
| Rate for Payer: Aetna of WY Medicare |
$3,275.58
|
| Rate for Payer: Aetna of WY Medicare |
$2,884.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,195.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,764.48
|
| Rate for Payer: Altius Commercial |
$4,764.48
|
| Rate for Payer: Altius Commercial |
$4,195.20
|
| Rate for Payer: Beech Street Commercial |
$4,282.60
|
| Rate for Payer: Beech Street Commercial |
$4,863.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,587.77
|
| Rate for Payer: Cash Price |
$3,059.00
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,238.90
|
| Rate for Payer: Cigna of WY Commercial |
$4,282.60
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: Entrust Commercial |
$4,714.85
|
| Rate for Payer: Entrust Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,151.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,878.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,534.60
|
| Rate for Payer: HealthUtah PPO |
$4,370.00
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,238.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$2,734.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2,407.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,282.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PacificSource Commercial |
$3,933.00
|
| Rate for Payer: PHCS PPO |
$4,282.60
|
| Rate for Payer: PHCS PPO |
$4,863.74
|
| Rate for Payer: Three Rivers PPO |
$3,277.50
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,878.54
|
| Rate for Payer: TriWest Veterans Administration |
$2,534.60
|
| Rate for Payer: United Healthcare Commercial |
$3,801.90
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$2,878.54
|
| Rate for Payer: United Healthcare Medicare |
$2,534.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,282.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,863.74
|
| Rate for Payer: Wise Provider Network Commercial |
$4,151.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,714.85
|
|
|
HC TRAUMA RESPONSE LEVEL 2
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
682G039001
|
|
Hospital Revenue Code
|
682
|
| Min. Negotiated Rate |
$3,111.80 |
| Max. Negotiated Rate |
$4,963.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,863.74
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,282.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,764.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,195.20
|
| Rate for Payer: Altius Commercial |
$4,195.20
|
| Rate for Payer: Altius Commercial |
$4,764.48
|
| Rate for Payer: Beech Street Commercial |
$4,863.74
|
| Rate for Payer: Beech Street Commercial |
$4,282.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,587.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.62
|
| Rate for Payer: Cash Price |
$3,474.10
|
| Rate for Payer: Cash Price |
$3,059.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,238.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,814.11
|
| Rate for Payer: Cigna of WY Commercial |
$4,863.74
|
| Rate for Payer: Cigna of WY Commercial |
$4,282.60
|
| Rate for Payer: Entrust Commercial |
$4,151.50
|
| Rate for Payer: Entrust Commercial |
$4,714.85
|
| Rate for Payer: First Choice Health Commercial |
$4,151.50
|
| Rate for Payer: First Choice Health Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,151.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,714.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,275.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,884.20
|
| Rate for Payer: HealthUtah PPO |
$4,963.00
|
| Rate for Payer: HealthUtah PPO |
$4,370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,238.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,814.11
|
| Rate for Payer: Multiplan Medicare/VA |
$3,111.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,739.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,863.74
|
| Rate for Payer: One Health Plan of WY PPO |
$4,282.60
|
| Rate for Payer: PacificSource Commercial |
$4,466.70
|
| Rate for Payer: PacificSource Commercial |
$3,933.00
|
| Rate for Payer: PHCS PPO |
$4,282.60
|
| Rate for Payer: PHCS PPO |
$4,863.74
|
| Rate for Payer: Three Rivers PPO |
$3,277.50
|
| Rate for Payer: Three Rivers PPO |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration |
$3,275.58
|
| Rate for Payer: TriWest Veterans Administration |
$2,884.20
|
| Rate for Payer: United Healthcare Commercial |
$3,801.90
|
| Rate for Payer: United Healthcare Commercial |
$4,317.81
|
| Rate for Payer: United Healthcare Medicare |
$3,275.58
|
| Rate for Payer: United Healthcare Medicare |
$2,884.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,151.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,714.85
|
| Rate for Payer: Wise Provider Network Commercial |
$4,151.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,714.85
|
|
|
HC TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
5102460001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Medicare |
$229.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$333.12
|
| Rate for Payer: Altius Commercial |
$333.12
|
| Rate for Payer: Beech Street Commercial |
$340.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.89
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: Entrust Commercial |
$329.65
|
| Rate for Payer: First Choice Health Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.26
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$191.20
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$340.06
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$201.26
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$201.26
|
| Rate for Payer: WINHealth Partners Commercial |
$340.06
|
| Rate for Payer: Wise Provider Network Commercial |
$329.65
|
|
|
HC TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
5102460001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.57 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$333.12
|
| Rate for Payer: Altius Commercial |
$333.12
|
| Rate for Payer: Beech Street Commercial |
$340.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.89
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: Entrust Commercial |
$329.65
|
| Rate for Payer: First Choice Health Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.02
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$217.57
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$340.06
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.02
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$229.02
|
| Rate for Payer: WINHealth Partners Commercial |
$329.65
|
| Rate for Payer: Wise Provider Network Commercial |
$329.65
|
|
|
HC TREATMENT VAGINAL NON-OB BLEEDING
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 57180
|
| Hospital Charge Code |
7615718001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC TREATMENT VAGINAL NON-OB BLEEDING
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 57180
|
| Hospital Charge Code |
7615718001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC TRICHOMONAS VAGINALIS DNA AMP PROB
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
3018766101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Aetna of WY Medicare |
$165.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$137.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$145.00
|
| Rate for Payer: WINHealth Partners Commercial |
$245.00
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC TRICHOMONAS VAGINALIS DNA AMP PROB
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
3018766101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$240.00
|
| Rate for Payer: Altius Commercial |
$240.00
|
| Rate for Payer: Beech Street Commercial |
$245.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$205.25
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.50
|
| Rate for Payer: Cigna of WY Commercial |
$245.00
|
| Rate for Payer: Entrust Commercial |
$237.50
|
| Rate for Payer: First Choice Health Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.00
|
| Rate for Payer: HealthUtah PPO |
$250.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.50
|
| Rate for Payer: Multiplan Medicare/VA |
$156.75
|
| Rate for Payer: One Health Plan of WY PPO |
$245.00
|
| Rate for Payer: PacificSource Commercial |
$225.00
|
| Rate for Payer: PHCS PPO |
$245.00
|
| Rate for Payer: Three Rivers PPO |
$187.50
|
| Rate for Payer: TriWest Veterans Administration |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$217.50
|
| Rate for Payer: United Healthcare Medicare |
$165.00
|
| Rate for Payer: WINHealth Partners Commercial |
$237.50
|
| Rate for Payer: Wise Provider Network Commercial |
$237.50
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
3018448201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
3018448201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.59 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.20
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$106.59
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$112.20
|
| Rate for Payer: WINHealth Partners Commercial |
$161.50
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$166.60
|
| Rate for Payer: Aetna of WY Medicare |
$112.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$163.20
|
| Rate for Payer: Altius Commercial |
$163.20
|
| Rate for Payer: Beech Street Commercial |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$139.57
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$164.90
|
| Rate for Payer: Cigna of WY Commercial |
$166.60
|
| Rate for Payer: Entrust Commercial |
$161.50
|
| Rate for Payer: First Choice Health Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$161.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.60
|
| Rate for Payer: HealthUtah PPO |
$170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$164.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.67
|
| Rate for Payer: One Health Plan of WY PPO |
$166.60
|
| Rate for Payer: PacificSource Commercial |
$153.00
|
| Rate for Payer: PHCS PPO |
$166.60
|
| Rate for Payer: Three Rivers PPO |
$127.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$147.90
|
| Rate for Payer: United Healthcare Medicare |
$98.60
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
| Rate for Payer: Wise Provider Network Commercial |
$161.50
|
|
|
HC TRIM BENIGH HYPERKERATOTIC SKIN LESION, SINGLE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
5101105501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$15.20
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC TRIM BENIGH HYPERKERATOTIC SKIN LESION, SINGLE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
5101105501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.68
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.36
|
| Rate for Payer: Altius Commercial |
$15.36
|
| Rate for Payer: Beech Street Commercial |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.52
|
| Rate for Payer: Cigna of WY Commercial |
$15.68
|
| Rate for Payer: Entrust Commercial |
$15.20
|
| Rate for Payer: First Choice Health Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$16.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.52
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$15.68
|
| Rate for Payer: PacificSource Commercial |
$14.40
|
| Rate for Payer: PHCS PPO |
$15.68
|
| Rate for Payer: Three Rivers PPO |
$12.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.92
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$15.68
|
| Rate for Payer: Wise Provider Network Commercial |
$15.20
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
5101105601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.34
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 11056
|
| Hospital Charge Code |
5101105601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.08
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.88
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$14.42
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,4+
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
5101105701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,4+
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
5101105701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
