|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.76
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$22.57
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.76
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Medicare |
$23.76
|
| Rate for Payer: WINHealth Partners Commercial |
$34.20
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3522060001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$536.08 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.30
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$536.08
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.30
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$564.30
|
| Rate for Payer: WINHealth Partners Commercial |
$812.25
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Aetna of WY Medicare |
$23.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.56
|
| Rate for Payer: Altius Commercial |
$34.56
|
| Rate for Payer: Beech Street Commercial |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.56
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: Entrust Commercial |
$34.20
|
| Rate for Payer: First Choice Health Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.88
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: Multiplan Medicare/VA |
$19.84
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$35.28
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$31.32
|
| Rate for Payer: United Healthcare Medicare |
$20.88
|
| Rate for Payer: WINHealth Partners Commercial |
$35.28
|
| Rate for Payer: Wise Provider Network Commercial |
$34.20
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3522060001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$837.90
|
| Rate for Payer: Aetna of WY Medicare |
$564.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$820.80
|
| Rate for Payer: Altius Commercial |
$820.80
|
| Rate for Payer: Beech Street Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.96
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$829.35
|
| Rate for Payer: Cigna of WY Commercial |
$837.90
|
| Rate for Payer: Entrust Commercial |
$812.25
|
| Rate for Payer: First Choice Health Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$812.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.90
|
| Rate for Payer: HealthUtah PPO |
$855.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$829.35
|
| Rate for Payer: Multiplan Medicare/VA |
$471.10
|
| Rate for Payer: One Health Plan of WY PPO |
$837.90
|
| Rate for Payer: PacificSource Commercial |
$769.50
|
| Rate for Payer: PHCS PPO |
$837.90
|
| Rate for Payer: Three Rivers PPO |
$641.25
|
| Rate for Payer: TriWest Veterans Administration |
$495.90
|
| Rate for Payer: United Healthcare Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare |
$495.90
|
| Rate for Payer: WINHealth Partners Commercial |
$837.90
|
| Rate for Payer: Wise Provider Network Commercial |
$812.25
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3202060001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$424.27 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$508.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$739.20
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$632.17
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$446.60
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$424.27
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$446.60
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$446.60
|
| Rate for Payer: WINHealth Partners Commercial |
$754.60
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3202060001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$482.79 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$739.20
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$632.17
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$508.20
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$482.79
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$508.20
|
| Rate for Payer: United Healthcare Commercial |
$669.90
|
| Rate for Payer: United Healthcare Medicare |
$508.20
|
| Rate for Payer: WINHealth Partners Commercial |
$731.50
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.16
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.29
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.86
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$44.52
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$46.86
|
| Rate for Payer: United Healthcare Commercial |
$61.77
|
| Rate for Payer: United Healthcare Medicare |
$46.86
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$46.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.16
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.29
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.18
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$39.12
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$41.18
|
| Rate for Payer: United Healthcare Commercial |
$61.77
|
| Rate for Payer: United Healthcare Medicare |
$41.18
|
| Rate for Payer: WINHealth Partners Commercial |
$69.58
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
7612060001
|
|
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 ARTHROCNT ASPIR INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4022060401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$796.29 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,244.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,219.20
|
| Rate for Payer: Altius Commercial |
$1,219.20
|
| Rate for Payer: Beech Street Commercial |
$1,244.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,042.67
|
| Rate for Payer: Cash Price |
$889.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,231.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,244.60
|
| Rate for Payer: Entrust Commercial |
$1,206.50
|
| Rate for Payer: First Choice Health Commercial |
$1,206.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,206.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$838.20
|
| Rate for Payer: HealthUtah PPO |
$1,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,231.90
|
| Rate for Payer: Multiplan Medicare/VA |
$796.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,244.60
|
| Rate for Payer: PacificSource Commercial |
$1,143.00
|
| Rate for Payer: PHCS PPO |
$1,244.60
|
| Rate for Payer: Three Rivers PPO |
$952.50
|
| Rate for Payer: TriWest Veterans Administration |
$838.20
|
| Rate for Payer: United Healthcare Commercial |
$1,104.90
|
| Rate for Payer: United Healthcare Medicare |
$838.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,206.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,206.50
|
|
|
HC ARTHROCNT ASPIR INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4022060401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$699.77 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,244.60
|
| Rate for Payer: Aetna of WY Medicare |
$838.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,219.20
|
| Rate for Payer: Altius Commercial |
$1,219.20
|
| Rate for Payer: Beech Street Commercial |
$1,244.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,042.67
|
| Rate for Payer: Cash Price |
$889.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,231.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,244.60
|
| Rate for Payer: Entrust Commercial |
$1,206.50
|
| Rate for Payer: First Choice Health Commercial |
$1,206.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,206.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.60
|
| Rate for Payer: HealthUtah PPO |
$1,270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,231.90
|
| Rate for Payer: Multiplan Medicare/VA |
$699.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,244.60
|
| Rate for Payer: PacificSource Commercial |
$1,143.00
|
| Rate for Payer: PHCS PPO |
$1,244.60
|
| Rate for Payer: Three Rivers PPO |
$952.50
|
| Rate for Payer: TriWest Veterans Administration |
$736.60
|
| Rate for Payer: United Healthcare Commercial |
$1,104.90
|
| Rate for Payer: United Healthcare Medicare |
$736.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,244.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,206.50
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| 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 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
5102060401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Aetna of WY Medicare |
$50.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.08
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$41.88
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.08
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$44.08
|
| Rate for Payer: WINHealth Partners Commercial |
$74.48
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| 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 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
5102060401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.65 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$74.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.96
|
| Rate for Payer: Altius Commercial |
$72.96
|
| Rate for Payer: Beech Street Commercial |
$74.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.72
|
| Rate for Payer: Cigna of WY Commercial |
$74.48
|
| Rate for Payer: Entrust Commercial |
$72.20
|
| Rate for Payer: First Choice Health Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.16
|
| Rate for Payer: HealthUtah PPO |
$76.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.72
|
| Rate for Payer: Multiplan Medicare/VA |
$47.65
|
| Rate for Payer: One Health Plan of WY PPO |
$74.48
|
| Rate for Payer: PacificSource Commercial |
$68.40
|
| Rate for Payer: PHCS PPO |
$74.48
|
| Rate for Payer: Three Rivers PPO |
$57.00
|
| Rate for Payer: TriWest Veterans Administration |
$50.16
|
| Rate for Payer: United Healthcare Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicare |
$50.16
|
| Rate for Payer: WINHealth Partners Commercial |
$72.20
|
| Rate for Payer: Wise Provider Network Commercial |
$72.20
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM LEFT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304001
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$793.16 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,214.40
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.56
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$834.90
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$793.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$834.90
|
| Rate for Payer: United Healthcare Commercial |
$1,100.55
|
| Rate for Payer: United Healthcare Medicare |
$834.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM LEFT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304001
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$697.02 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$834.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,214.40
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.56
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.70
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$697.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.70
|
| Rate for Payer: United Healthcare Commercial |
$1,100.55
|
| Rate for Payer: United Healthcare Medicare |
$733.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304002
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$697.02 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Aetna of WY Medicare |
$834.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,214.40
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.56
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$733.70
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$697.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$733.70
|
| Rate for Payer: United Healthcare Commercial |
$1,100.55
|
| Rate for Payer: United Healthcare Medicare |
$733.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
3227304002
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$793.16 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,239.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,214.40
|
| Rate for Payer: Altius Commercial |
$1,214.40
|
| Rate for Payer: Beech Street Commercial |
$1,239.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,038.56
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,227.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,239.70
|
| Rate for Payer: Entrust Commercial |
$1,201.75
|
| Rate for Payer: First Choice Health Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,201.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$834.90
|
| Rate for Payer: HealthUtah PPO |
$1,265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,227.05
|
| Rate for Payer: Multiplan Medicare/VA |
$793.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,239.70
|
| Rate for Payer: PacificSource Commercial |
$1,138.50
|
| Rate for Payer: PHCS PPO |
$1,239.70
|
| Rate for Payer: Three Rivers PPO |
$948.75
|
| Rate for Payer: TriWest Veterans Administration |
$834.90
|
| Rate for Payer: United Healthcare Commercial |
$1,100.55
|
| Rate for Payer: United Healthcare Medicare |
$834.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,201.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,201.75
|
|
|
HC ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
5102310701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$423.85 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$648.96
|
| Rate for Payer: Altius Commercial |
$648.96
|
| Rate for Payer: Beech Street Commercial |
$662.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.00
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$655.72
|
| Rate for Payer: Cigna of WY Commercial |
$662.48
|
| Rate for Payer: Entrust Commercial |
$642.20
|
| Rate for Payer: First Choice Health Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$446.16
|
| Rate for Payer: HealthUtah PPO |
$676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
| Rate for Payer: Multiplan Medicare/VA |
$423.85
|
| Rate for Payer: One Health Plan of WY PPO |
$662.48
|
| Rate for Payer: PacificSource Commercial |
$608.40
|
| Rate for Payer: PHCS PPO |
$662.48
|
| Rate for Payer: Three Rivers PPO |
$507.00
|
| Rate for Payer: TriWest Veterans Administration |
$446.16
|
| Rate for Payer: United Healthcare Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicare |
$446.16
|
| Rate for Payer: WINHealth Partners Commercial |
$642.20
|
| Rate for Payer: Wise Provider Network Commercial |
$642.20
|
|
|
HC ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
5102310701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$662.48
|
| Rate for Payer: Aetna of WY Medicare |
$446.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$648.96
|
| Rate for Payer: Altius Commercial |
$648.96
|
| Rate for Payer: Beech Street Commercial |
$662.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.00
|
| Rate for Payer: Cash Price |
$473.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$655.72
|
| Rate for Payer: Cigna of WY Commercial |
$662.48
|
| Rate for Payer: Entrust Commercial |
$642.20
|
| Rate for Payer: First Choice Health Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$642.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$392.08
|
| Rate for Payer: HealthUtah PPO |
$676.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$655.72
|
| Rate for Payer: Multiplan Medicare/VA |
$372.48
|
| Rate for Payer: One Health Plan of WY PPO |
$662.48
|
| Rate for Payer: PacificSource Commercial |
$608.40
|
| Rate for Payer: PHCS PPO |
$662.48
|
| Rate for Payer: Three Rivers PPO |
$507.00
|
| Rate for Payer: TriWest Veterans Administration |
$392.08
|
| Rate for Payer: United Healthcare Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicare |
$392.08
|
| Rate for Payer: WINHealth Partners Commercial |
$662.48
|
| Rate for Payer: Wise Provider Network Commercial |
$642.20
|
|
|
HC ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 58321
|
| Hospital Charge Code |
5105832101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Aetna of WY Medicare |
$44.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.32
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.01
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.86
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$36.92
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.86
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
| Rate for Payer: United Healthcare Medicare |
$38.86
|
| Rate for Payer: WINHealth Partners Commercial |
$65.66
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 58321
|
| Hospital Charge Code |
5105832101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.32
|
| Rate for Payer: Altius Commercial |
$64.32
|
| Rate for Payer: Beech Street Commercial |
$65.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55.01
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.99
|
| Rate for Payer: Cigna of WY Commercial |
$65.66
|
| Rate for Payer: Entrust Commercial |
$63.65
|
| Rate for Payer: First Choice Health Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.22
|
| Rate for Payer: HealthUtah PPO |
$67.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.99
|
| Rate for Payer: Multiplan Medicare/VA |
$42.01
|
| Rate for Payer: One Health Plan of WY PPO |
$65.66
|
| Rate for Payer: PacificSource Commercial |
$60.30
|
| Rate for Payer: PHCS PPO |
$65.66
|
| Rate for Payer: Three Rivers PPO |
$50.25
|
| Rate for Payer: TriWest Veterans Administration |
$44.22
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
| Rate for Payer: United Healthcare Medicare |
$44.22
|
| Rate for Payer: WINHealth Partners Commercial |
$63.65
|
| Rate for Payer: Wise Provider Network Commercial |
$63.65
|
|
|
HC ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
5105832201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Aetna of WY Medicare |
$63.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.68
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$52.90
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$55.68
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$55.68
|
| Rate for Payer: WINHealth Partners Commercial |
$94.08
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
|
HC ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
5105832201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$94.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$92.16
|
| Rate for Payer: Altius Commercial |
$92.16
|
| Rate for Payer: Beech Street Commercial |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$93.12
|
| Rate for Payer: Cigna of WY Commercial |
$94.08
|
| Rate for Payer: Entrust Commercial |
$91.20
|
| Rate for Payer: First Choice Health Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$91.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.36
|
| Rate for Payer: HealthUtah PPO |
$96.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$93.12
|
| Rate for Payer: Multiplan Medicare/VA |
$60.19
|
| Rate for Payer: One Health Plan of WY PPO |
$94.08
|
| Rate for Payer: PacificSource Commercial |
$86.40
|
| Rate for Payer: PHCS PPO |
$94.08
|
| Rate for Payer: Three Rivers PPO |
$72.00
|
| Rate for Payer: TriWest Veterans Administration |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$83.52
|
| Rate for Payer: United Healthcare Medicare |
$63.36
|
| Rate for Payer: WINHealth Partners Commercial |
$91.20
|
| Rate for Payer: Wise Provider Network Commercial |
$91.20
|
|
