|
HC TRIM HYPERKERATOTIC SKIN LESION, ONE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
7611105501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC TRIM HYPERKERATOTIC SKIN LESION, ONE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
7611105501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC TRIM NONDYSTROPHIC NAILS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Aetna of WY Medicare |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$7.84
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC TRIM NONDYSTROPHIC NAILS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
HC TRIM NONDYSTROPHIC NAILS
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
7611171901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC TRIM NONDYSTROPHIC NAILS
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
7611171901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC TTE F-UP OR LMTD - TTE LIMITED
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330807
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$727.32 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,136.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,113.60
|
| Rate for Payer: Altius Commercial |
$1,113.60
|
| Rate for Payer: Beech Street Commercial |
$1,136.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$952.36
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,125.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,136.80
|
| Rate for Payer: Entrust Commercial |
$1,102.00
|
| Rate for Payer: First Choice Health Commercial |
$1,102.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,102.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$765.60
|
| Rate for Payer: HealthUtah PPO |
$1,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,125.20
|
| Rate for Payer: Multiplan Medicare/VA |
$727.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,136.80
|
| Rate for Payer: PacificSource Commercial |
$1,044.00
|
| Rate for Payer: PHCS PPO |
$1,136.80
|
| Rate for Payer: Three Rivers PPO |
$870.00
|
| Rate for Payer: TriWest Veterans Administration |
$765.60
|
| Rate for Payer: United Healthcare Commercial |
$1,009.20
|
| Rate for Payer: United Healthcare Medicare |
$765.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,102.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,102.00
|
|
|
HC TTE F-UP OR LMTD - TTE LIMITED
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330807
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$639.16 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,136.80
|
| Rate for Payer: Aetna of WY Medicare |
$765.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,113.60
|
| Rate for Payer: Altius Commercial |
$1,113.60
|
| Rate for Payer: Beech Street Commercial |
$1,136.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$952.36
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,125.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,136.80
|
| Rate for Payer: Entrust Commercial |
$1,102.00
|
| Rate for Payer: First Choice Health Commercial |
$1,102.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,102.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$672.80
|
| Rate for Payer: HealthUtah PPO |
$1,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,125.20
|
| Rate for Payer: Multiplan Medicare/VA |
$639.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,136.80
|
| Rate for Payer: PacificSource Commercial |
$1,044.00
|
| Rate for Payer: PHCS PPO |
$1,136.80
|
| Rate for Payer: Three Rivers PPO |
$870.00
|
| Rate for Payer: TriWest Veterans Administration |
$672.80
|
| Rate for Payer: United Healthcare Commercial |
$1,009.20
|
| Rate for Payer: United Healthcare Medicare |
$672.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,136.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,102.00
|
|
|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE
|
Facility
|
IP
|
$4,225.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330602
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,649.08 |
| Max. Negotiated Rate |
$4,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,140.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,056.00
|
| Rate for Payer: Altius Commercial |
$4,056.00
|
| Rate for Payer: Beech Street Commercial |
$4,140.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,468.72
|
| Rate for Payer: Cash Price |
$2,957.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,098.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,140.50
|
| Rate for Payer: Entrust Commercial |
$4,013.75
|
| Rate for Payer: First Choice Health Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,788.50
|
| Rate for Payer: HealthUtah PPO |
$4,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,098.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,649.08
|
| Rate for Payer: One Health Plan of WY PPO |
$4,140.50
|
| Rate for Payer: PacificSource Commercial |
$3,802.50
|
| Rate for Payer: PHCS PPO |
$4,140.50
|
| Rate for Payer: Three Rivers PPO |
$3,168.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,788.50
|
| Rate for Payer: United Healthcare Commercial |
$3,675.75
|
| Rate for Payer: United Healthcare Medicare |
$2,788.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,013.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,013.75
|
|
|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE
|
Facility
|
OP
|
$4,225.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330602
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,327.98 |
| Max. Negotiated Rate |
$4,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,140.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,788.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,056.00
|
| Rate for Payer: Altius Commercial |
$4,056.00
|
| Rate for Payer: Beech Street Commercial |
$4,140.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,468.72
|
| Rate for Payer: Cash Price |
$2,957.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,098.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,140.50
|
| Rate for Payer: Entrust Commercial |
$4,013.75
|
| Rate for Payer: First Choice Health Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,450.50
|
| Rate for Payer: HealthUtah PPO |
$4,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,098.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,327.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4,140.50
|
| Rate for Payer: PacificSource Commercial |
$3,802.50
|
| Rate for Payer: PHCS PPO |
$4,140.50
|
| Rate for Payer: Three Rivers PPO |
$3,168.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,450.50
|
| Rate for Payer: United Healthcare Commercial |
$3,675.75
|
| Rate for Payer: United Healthcare Medicare |
$2,450.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,140.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,013.75
|
|
|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE W/BUBBLES
|
Facility
|
OP
|
$4,225.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330603
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,327.98 |
| Max. Negotiated Rate |
$4,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,140.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,788.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,056.00
|
| Rate for Payer: Altius Commercial |
$4,056.00
|
| Rate for Payer: Beech Street Commercial |
$4,140.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,468.72
|
| Rate for Payer: Cash Price |
$2,957.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,098.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,140.50
|
| Rate for Payer: Entrust Commercial |
$4,013.75
|
| Rate for Payer: First Choice Health Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,450.50
|
| Rate for Payer: HealthUtah PPO |
$4,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,098.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,327.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4,140.50
|
| Rate for Payer: PacificSource Commercial |
$3,802.50
|
| Rate for Payer: PHCS PPO |
$4,140.50
|
| Rate for Payer: Three Rivers PPO |
$3,168.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,450.50
|
| Rate for Payer: United Healthcare Commercial |
$3,675.75
|
| Rate for Payer: United Healthcare Medicare |
$2,450.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,140.50
|
| Rate for Payer: Wise Provider Network Commercial |
$4,013.75
|
|
|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE W/BUBBLES
|
Facility
|
IP
|
$4,225.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330603
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,649.08 |
| Max. Negotiated Rate |
$4,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,140.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,056.00
|
| Rate for Payer: Altius Commercial |
$4,056.00
|
| Rate for Payer: Beech Street Commercial |
$4,140.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,468.72
|
| Rate for Payer: Cash Price |
$2,957.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,098.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,140.50
|
| Rate for Payer: Entrust Commercial |
$4,013.75
|
| Rate for Payer: First Choice Health Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,013.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,788.50
|
| Rate for Payer: HealthUtah PPO |
$4,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,098.25
|
| Rate for Payer: Multiplan Medicare/VA |
$2,649.08
|
| Rate for Payer: One Health Plan of WY PPO |
$4,140.50
|
| Rate for Payer: PacificSource Commercial |
$3,802.50
|
| Rate for Payer: PHCS PPO |
$4,140.50
|
| Rate for Payer: Three Rivers PPO |
$3,168.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,788.50
|
| Rate for Payer: United Healthcare Commercial |
$3,675.75
|
| Rate for Payer: United Healthcare Medicare |
$2,788.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4,013.75
|
| Rate for Payer: Wise Provider Network Commercial |
$4,013.75
|
|
|
HC TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
7613255101
|
|
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 TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
7613255101
|
|
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 TX LS TRSL FX W/O MAN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
7612845001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC TX LS TRSL FX W/O MAN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
7612845001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
5101202001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$185.22
|
| Rate for Payer: Aetna of WY Medicare |
$124.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$181.44
|
| Rate for Payer: Altius Commercial |
$181.44
|
| Rate for Payer: Beech Street Commercial |
$185.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.17
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$183.33
|
| Rate for Payer: Cigna of WY Commercial |
$185.22
|
| Rate for Payer: Entrust Commercial |
$179.55
|
| Rate for Payer: First Choice Health Commercial |
$179.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$179.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.62
|
| Rate for Payer: HealthUtah PPO |
$189.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$183.33
|
| Rate for Payer: Multiplan Medicare/VA |
$104.14
|
| Rate for Payer: One Health Plan of WY PPO |
$185.22
|
| Rate for Payer: PacificSource Commercial |
$170.10
|
| Rate for Payer: PHCS PPO |
$185.22
|
| Rate for Payer: Three Rivers PPO |
$141.75
|
| Rate for Payer: TriWest Veterans Administration |
$109.62
|
| Rate for Payer: United Healthcare Commercial |
$164.43
|
| Rate for Payer: United Healthcare Medicare |
$109.62
|
| Rate for Payer: WINHealth Partners Commercial |
$185.22
|
| Rate for Payer: Wise Provider Network Commercial |
$179.55
|
|
|
HC TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
5101202001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$185.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$181.44
|
| Rate for Payer: Altius Commercial |
$181.44
|
| Rate for Payer: Beech Street Commercial |
$185.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.17
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$183.33
|
| Rate for Payer: Cigna of WY Commercial |
$185.22
|
| Rate for Payer: Entrust Commercial |
$179.55
|
| Rate for Payer: First Choice Health Commercial |
$179.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$179.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.74
|
| Rate for Payer: HealthUtah PPO |
$189.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$183.33
|
| Rate for Payer: Multiplan Medicare/VA |
$118.50
|
| Rate for Payer: One Health Plan of WY PPO |
$185.22
|
| Rate for Payer: PacificSource Commercial |
$170.10
|
| Rate for Payer: PHCS PPO |
$185.22
|
| Rate for Payer: Three Rivers PPO |
$141.75
|
| Rate for Payer: TriWest Veterans Administration |
$124.74
|
| Rate for Payer: United Healthcare Commercial |
$164.43
|
| Rate for Payer: United Healthcare Medicare |
$124.74
|
| Rate for Payer: WINHealth Partners Commercial |
$179.55
|
| Rate for Payer: Wise Provider Network Commercial |
$179.55
|
|
|
HC TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
5102845501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.36
|
| Rate for Payer: Altius Commercial |
$255.36
|
| Rate for Payer: Beech Street Commercial |
$260.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.39
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.02
|
| Rate for Payer: Cigna of WY Commercial |
$260.68
|
| Rate for Payer: Entrust Commercial |
$252.70
|
| Rate for Payer: First Choice Health Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.56
|
| Rate for Payer: HealthUtah PPO |
$266.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.02
|
| Rate for Payer: Multiplan Medicare/VA |
$166.78
|
| Rate for Payer: One Health Plan of WY PPO |
$260.68
|
| Rate for Payer: PacificSource Commercial |
$239.40
|
| Rate for Payer: PHCS PPO |
$260.68
|
| Rate for Payer: Three Rivers PPO |
$199.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$231.42
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
| Rate for Payer: WINHealth Partners Commercial |
$252.70
|
| Rate for Payer: Wise Provider Network Commercial |
$252.70
|
|
|
HC TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
5102845501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.57 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.68
|
| Rate for Payer: Aetna of WY Medicare |
$175.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.36
|
| Rate for Payer: Altius Commercial |
$255.36
|
| Rate for Payer: Beech Street Commercial |
$260.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.39
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.02
|
| Rate for Payer: Cigna of WY Commercial |
$260.68
|
| Rate for Payer: Entrust Commercial |
$252.70
|
| Rate for Payer: First Choice Health Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.28
|
| Rate for Payer: HealthUtah PPO |
$266.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.02
|
| Rate for Payer: Multiplan Medicare/VA |
$146.57
|
| Rate for Payer: One Health Plan of WY PPO |
$260.68
|
| Rate for Payer: PacificSource Commercial |
$239.40
|
| Rate for Payer: PHCS PPO |
$260.68
|
| Rate for Payer: Three Rivers PPO |
$199.50
|
| Rate for Payer: TriWest Veterans Administration |
$154.28
|
| Rate for Payer: United Healthcare Commercial |
$231.42
|
| Rate for Payer: United Healthcare Medicare |
$154.28
|
| Rate for Payer: WINHealth Partners Commercial |
$260.68
|
| Rate for Payer: Wise Provider Network Commercial |
$252.70
|
|
|
HC TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
5102845001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.02
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.52
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.02
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$130.02
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
5102845001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.26
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$108.55
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$114.26
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
3108135001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,181.90 |
| Max. Negotiated Rate |
$2,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,102.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,415.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,059.20
|
| Rate for Payer: Altius Commercial |
$2,059.20
|
| Rate for Payer: Beech Street Commercial |
$2,102.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,761.04
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,080.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,102.10
|
| Rate for Payer: Entrust Commercial |
$2,037.75
|
| Rate for Payer: First Choice Health Commercial |
$2,037.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,037.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,244.10
|
| Rate for Payer: HealthUtah PPO |
$2,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,080.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,181.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,102.10
|
| Rate for Payer: PacificSource Commercial |
$1,930.50
|
| Rate for Payer: PHCS PPO |
$2,102.10
|
| Rate for Payer: Three Rivers PPO |
$1,608.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,244.10
|
| Rate for Payer: United Healthcare Commercial |
$1,866.15
|
| Rate for Payer: United Healthcare Medicare |
$1,244.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,102.10
|
| Rate for Payer: Wise Provider Network Commercial |
$2,037.75
|
|
|
HC UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
3108135001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,344.92 |
| Max. Negotiated Rate |
$2,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,102.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,059.20
|
| Rate for Payer: Altius Commercial |
$2,059.20
|
| Rate for Payer: Beech Street Commercial |
$2,102.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,761.04
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,080.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,102.10
|
| Rate for Payer: Entrust Commercial |
$2,037.75
|
| Rate for Payer: First Choice Health Commercial |
$2,037.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,037.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,415.70
|
| Rate for Payer: HealthUtah PPO |
$2,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,080.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,344.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,102.10
|
| Rate for Payer: PacificSource Commercial |
$1,930.50
|
| Rate for Payer: PHCS PPO |
$2,102.10
|
| Rate for Payer: Three Rivers PPO |
$1,608.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,415.70
|
| Rate for Payer: United Healthcare Commercial |
$1,866.15
|
| Rate for Payer: United Healthcare Medicare |
$1,415.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,037.75
|
|
|
HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US INTRAOPERATIVE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
4027699802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$551.13 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$861.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$843.84
|
| Rate for Payer: Altius Commercial |
$843.84
|
| Rate for Payer: Beech Street Commercial |
$861.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$721.66
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$852.63
|
| Rate for Payer: Cigna of WY Commercial |
$861.42
|
| Rate for Payer: Entrust Commercial |
$835.05
|
| Rate for Payer: First Choice Health Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$835.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$580.14
|
| Rate for Payer: HealthUtah PPO |
$879.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$852.63
|
| Rate for Payer: Multiplan Medicare/VA |
$551.13
|
| Rate for Payer: One Health Plan of WY PPO |
$861.42
|
| Rate for Payer: PacificSource Commercial |
$791.10
|
| Rate for Payer: PHCS PPO |
$861.42
|
| Rate for Payer: Three Rivers PPO |
$659.25
|
| Rate for Payer: TriWest Veterans Administration |
$580.14
|
| Rate for Payer: United Healthcare Commercial |
$764.73
|
| Rate for Payer: United Healthcare Medicare |
$580.14
|
| Rate for Payer: WINHealth Partners Commercial |
$835.05
|
| Rate for Payer: Wise Provider Network Commercial |
$835.05
|
|
