|
HC APPLY LONG LEG SPLINT
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
7002950501
|
|
Hospital Revenue Code
|
700
|
| 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 APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7612951501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.17 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$383.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.58
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$250.17
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$263.34
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$263.34
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$379.05
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7612951501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$263.34
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$383.04
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$219.85
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$231.42
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$231.42
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: WINHealth Partners Commercial |
$391.02
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 29515 50
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.92
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.32
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$63.95
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$67.32
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$67.32
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.66
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$31.98
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$33.66
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7002951501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$313.50
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$261.72
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.50
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$275.50
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 29515 50
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$67.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.92
|
| Rate for Payer: Altius Commercial |
$97.92
|
| Rate for Payer: Beech Street Commercial |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.74
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: Entrust Commercial |
$96.90
|
| Rate for Payer: First Choice Health Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.16
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$56.20
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$99.96
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.16
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$59.16
|
| Rate for Payer: WINHealth Partners Commercial |
$99.96
|
| Rate for Payer: Wise Provider Network Commercial |
$96.90
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7002951501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$297.82 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| 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) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$297.82
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$313.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$451.25
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
5101527101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.48 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$280.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$266.48
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$280.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$280.50
|
| Rate for Payer: WINHealth Partners Commercial |
$403.75
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
5101527101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.18 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$416.50
|
| Rate for Payer: Aetna of WY Medicare |
$280.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$408.00
|
| Rate for Payer: Altius Commercial |
$408.00
|
| Rate for Payer: Beech Street Commercial |
$416.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.92
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$412.25
|
| Rate for Payer: Cigna of WY Commercial |
$416.50
|
| Rate for Payer: Entrust Commercial |
$403.75
|
| Rate for Payer: First Choice Health Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$403.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.50
|
| Rate for Payer: HealthUtah PPO |
$425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$412.25
|
| Rate for Payer: Multiplan Medicare/VA |
$234.18
|
| Rate for Payer: One Health Plan of WY PPO |
$416.50
|
| Rate for Payer: PacificSource Commercial |
$382.50
|
| Rate for Payer: PHCS PPO |
$416.50
|
| Rate for Payer: Three Rivers PPO |
$318.75
|
| Rate for Payer: TriWest Veterans Administration |
$246.50
|
| Rate for Payer: United Healthcare Commercial |
$369.75
|
| Rate for Payer: United Healthcare Medicare |
$246.50
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
| Rate for Payer: Wise Provider Network Commercial |
$403.75
|
|
|
HC AQUAPORIN-4 ANTB CBA
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 86052
|
| Hospital Charge Code |
3008605201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.40
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$25.08
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.40
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$26.40
|
| Rate for Payer: WINHealth Partners Commercial |
$38.00
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC AQUAPORIN-4 ANTB CBA
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86052
|
| Hospital Charge Code |
3008605201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.20
|
| Rate for Payer: Aetna of WY Medicare |
$26.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.40
|
| Rate for Payer: Altius Commercial |
$38.40
|
| Rate for Payer: Beech Street Commercial |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.84
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$39.20
|
| Rate for Payer: Entrust Commercial |
$38.00
|
| Rate for Payer: First Choice Health Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.20
|
| Rate for Payer: HealthUtah PPO |
$40.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.80
|
| Rate for Payer: Multiplan Medicare/VA |
$22.04
|
| Rate for Payer: One Health Plan of WY PPO |
$39.20
|
| Rate for Payer: PacificSource Commercial |
$36.00
|
| Rate for Payer: PHCS PPO |
$39.20
|
| Rate for Payer: Three Rivers PPO |
$30.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.20
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WINHealth Partners Commercial |
$39.20
|
| Rate for Payer: Wise Provider Network Commercial |
$38.00
|
|
|
HC AQUAPORIN-4 RECEPTOR AB
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC AQUAPORIN-4 RECEPTOR AB
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
3003660001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Aetna of WY Medicare |
$118.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.40
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$99.18
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WINHealth Partners Commercial |
$176.40
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
3003660001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.86 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.80
|
| Rate for Payer: Altius Commercial |
$172.80
|
| Rate for Payer: Beech Street Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.78
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.60
|
| Rate for Payer: Cigna of WY Commercial |
$176.40
|
| Rate for Payer: Entrust Commercial |
$171.00
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.80
|
| Rate for Payer: HealthUtah PPO |
$180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.86
|
| Rate for Payer: One Health Plan of WY PPO |
$176.40
|
| Rate for Payer: PacificSource Commercial |
$162.00
|
| Rate for Payer: PHCS PPO |
$176.40
|
| Rate for Payer: Three Rivers PPO |
$135.00
|
| Rate for Payer: TriWest Veterans Administration |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$156.60
|
| Rate for Payer: United Healthcare Medicare |
$118.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.00
|
| Rate for Payer: Wise Provider Network Commercial |
$171.00
|
|
|
HC ARTHORSCOPY PROCEDURE
|
Facility
|
OP
|
$2,520.00
|
|
| Hospital Charge Code |
3600000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,388.52 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,469.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,663.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,419.20
|
| Rate for Payer: Altius Commercial |
$2,419.20
|
| Rate for Payer: Beech Street Commercial |
$2,469.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,068.92
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,444.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,469.60
|
| Rate for Payer: Entrust Commercial |
$2,394.00
|
| Rate for Payer: First Choice Health Commercial |
$2,394.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,394.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,461.60
|
| Rate for Payer: HealthUtah PPO |
$2,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,444.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,388.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,469.60
|
| Rate for Payer: PacificSource Commercial |
$2,268.00
|
| Rate for Payer: PHCS PPO |
$2,469.60
|
| Rate for Payer: Three Rivers PPO |
$1,890.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,461.60
|
| Rate for Payer: United Healthcare Commercial |
$2,192.40
|
| Rate for Payer: United Healthcare Medicare |
$1,461.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,469.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,394.00
|
|
|
HC ARTHORSCOPY PROCEDURE
|
Facility
|
IP
|
$2,520.00
|
|
| Hospital Charge Code |
3600000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.04 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,469.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,419.20
|
| Rate for Payer: Altius Commercial |
$2,419.20
|
| Rate for Payer: Beech Street Commercial |
$2,469.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,068.92
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,444.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,469.60
|
| Rate for Payer: Entrust Commercial |
$2,394.00
|
| Rate for Payer: First Choice Health Commercial |
$2,394.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,394.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,663.20
|
| Rate for Payer: HealthUtah PPO |
$2,520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,444.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,580.04
|
| Rate for Payer: One Health Plan of WY PPO |
$2,469.60
|
| Rate for Payer: PacificSource Commercial |
$2,268.00
|
| Rate for Payer: PHCS PPO |
$2,469.60
|
| Rate for Payer: Three Rivers PPO |
$1,890.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$2,192.40
|
| Rate for Payer: United Healthcare Medicare |
$1,663.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,394.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,394.00
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
7612060501
|
|
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 ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
3522060501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$380.19 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$455.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.20
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$380.19
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$400.20
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$400.20
|
| Rate for Payer: WINHealth Partners Commercial |
$676.20
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
5102060501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
3202060501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$666.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$652.80
|
| Rate for Payer: Altius Commercial |
$652.80
|
| Rate for Payer: Beech Street Commercial |
$666.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$558.28
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$659.60
|
| Rate for Payer: Cigna of WY Commercial |
$666.40
|
| Rate for Payer: Entrust Commercial |
$646.00
|
| Rate for Payer: First Choice Health Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$646.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.80
|
| Rate for Payer: HealthUtah PPO |
$680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$659.60
|
| Rate for Payer: Multiplan Medicare/VA |
$426.36
|
| Rate for Payer: One Health Plan of WY PPO |
$666.40
|
| Rate for Payer: PacificSource Commercial |
$612.00
|
| Rate for Payer: PHCS PPO |
$666.40
|
| Rate for Payer: Three Rivers PPO |
$510.00
|
| Rate for Payer: TriWest Veterans Administration |
$448.80
|
| Rate for Payer: United Healthcare Commercial |
$591.60
|
| Rate for Payer: United Healthcare Medicare |
$448.80
|
| Rate for Payer: WINHealth Partners Commercial |
$646.00
|
| Rate for Payer: Wise Provider Network Commercial |
$646.00
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
3522060501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$432.63 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.40
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$432.63
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$455.40
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
| Rate for Payer: WINHealth Partners Commercial |
$655.50
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Hospital Charge Code |
5102060501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
