|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
3202060501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.31 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$644.84
|
| Rate for Payer: Aetna of WY Medicare |
$434.28
|
| Rate for Payer: Altius Commercial |
$631.68
|
| Rate for Payer: Beech Street Commercial |
$644.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$638.26
|
| Rate for Payer: Cash Price |
$460.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$638.26
|
| Rate for Payer: Cigna of WY Commercial |
$644.84
|
| Rate for Payer: Entrust Commercial |
$625.10
|
| Rate for Payer: First Choice Health Commercial |
$625.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$625.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$375.06
|
| Rate for Payer: HealthUtah PPO |
$658.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$638.26
|
| Rate for Payer: Multiplan Medicare/VA |
$356.31
|
| Rate for Payer: One Health Plan of WY PPO |
$644.84
|
| Rate for Payer: PacificSource Commercial |
$592.20
|
| Rate for Payer: PHCS PPO |
$644.84
|
| Rate for Payer: Three Rivers PPO |
$493.50
|
| Rate for Payer: TriWest Veterans Administration |
$375.06
|
| Rate for Payer: United Healthcare Commercial |
$628.39
|
| Rate for Payer: United Healthcare Medicare |
$375.06
|
| Rate for Payer: WINHealth Partners Commercial |
$644.84
|
| Rate for Payer: Wise Provider Network Commercial |
$625.10
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
7612060501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
7612060501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
3202060501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$381.31 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$644.84
|
| Rate for Payer: Aetna of WY Medicare |
$421.12
|
| Rate for Payer: Altius Commercial |
$631.68
|
| Rate for Payer: Beech Street Commercial |
$644.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$638.26
|
| Rate for Payer: Cash Price |
$460.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$638.26
|
| Rate for Payer: Cigna of WY Commercial |
$644.84
|
| Rate for Payer: Entrust Commercial |
$625.10
|
| Rate for Payer: First Choice Health Commercial |
$625.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$625.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.38
|
| Rate for Payer: HealthUtah PPO |
$658.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$638.26
|
| Rate for Payer: Multiplan Medicare/VA |
$381.31
|
| Rate for Payer: One Health Plan of WY PPO |
$644.84
|
| Rate for Payer: PacificSource Commercial |
$592.20
|
| Rate for Payer: PHCS PPO |
$644.84
|
| Rate for Payer: Three Rivers PPO |
$493.50
|
| Rate for Payer: TriWest Veterans Administration |
$401.38
|
| Rate for Payer: United Healthcare Commercial |
$628.39
|
| Rate for Payer: United Healthcare Medicare |
$401.38
|
| Rate for Payer: WINHealth Partners Commercial |
$625.10
|
| Rate for Payer: Wise Provider Network Commercial |
$625.10
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$2,999.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
3202060601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,623.96 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,979.34
|
| Rate for Payer: Altius Commercial |
$2,879.04
|
| Rate for Payer: Beech Street Commercial |
$2,939.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,909.03
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: Entrust Commercial |
$2,849.05
|
| Rate for Payer: First Choice Health Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,709.43
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,623.96
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,939.02
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,709.43
|
| Rate for Payer: United Healthcare Commercial |
$2,864.04
|
| Rate for Payer: United Healthcare Medicare |
$1,709.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,939.02
|
| Rate for Payer: Wise Provider Network Commercial |
$2,849.05
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$2,999.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
4022060601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,623.96 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,979.34
|
| Rate for Payer: Altius Commercial |
$2,879.04
|
| Rate for Payer: Beech Street Commercial |
$2,939.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,909.03
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: Entrust Commercial |
$2,849.05
|
| Rate for Payer: First Choice Health Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,709.43
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,623.96
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,939.02
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,709.43
|
| Rate for Payer: United Healthcare Commercial |
$2,864.04
|
| Rate for Payer: United Healthcare Medicare |
$1,709.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,939.02
|
| Rate for Payer: Wise Provider Network Commercial |
$2,849.05
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$2,999.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
4022060601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,737.92 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,919.36
|
| Rate for Payer: Altius Commercial |
$2,879.04
|
| Rate for Payer: Beech Street Commercial |
$2,939.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,909.03
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: Entrust Commercial |
$2,849.05
|
| Rate for Payer: First Choice Health Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,829.39
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,737.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,939.02
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,829.39
|
| Rate for Payer: United Healthcare Commercial |
$2,864.04
|
| Rate for Payer: United Healthcare Medicare |
$1,829.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,849.05
|
| Rate for Payer: Wise Provider Network Commercial |
$2,849.05
|
|
|
HC ARTHROCENTESIS ASPIR INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$2,999.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
3202060601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,737.92 |
| Max. Negotiated Rate |
$2,999.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,939.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,919.36
|
| Rate for Payer: Altius Commercial |
$2,879.04
|
| Rate for Payer: Beech Street Commercial |
$2,939.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,909.03
|
| Rate for Payer: Cash Price |
$2,099.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,909.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,939.02
|
| Rate for Payer: Entrust Commercial |
$2,849.05
|
| Rate for Payer: First Choice Health Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,849.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,829.39
|
| Rate for Payer: HealthUtah PPO |
$2,999.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,909.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,737.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,939.02
|
| Rate for Payer: PacificSource Commercial |
$2,699.10
|
| Rate for Payer: PHCS PPO |
$2,939.02
|
| Rate for Payer: Three Rivers PPO |
$2,249.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,829.39
|
| Rate for Payer: United Healthcare Commercial |
$2,864.04
|
| Rate for Payer: United Healthcare Medicare |
$1,829.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,849.05
|
| Rate for Payer: Wise Provider Network Commercial |
$2,849.05
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
7612061001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3522061001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$430.98
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.21
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$353.60
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.21
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$372.21
|
| Rate for Payer: WINHealth Partners Commercial |
$639.94
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3522061001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$417.92
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$398.33
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$378.41
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$398.33
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$398.33
|
| Rate for Payer: WINHealth Partners Commercial |
$620.35
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3202061001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$417.92
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$398.33
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$378.41
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$398.33
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$398.33
|
| Rate for Payer: WINHealth Partners Commercial |
$620.35
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
7612061001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3202061001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$653.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$639.94
|
| Rate for Payer: Aetna of WY Medicare |
$430.98
|
| Rate for Payer: Altius Commercial |
$626.88
|
| Rate for Payer: Beech Street Commercial |
$639.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$633.41
|
| Rate for Payer: Cash Price |
$457.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$633.41
|
| Rate for Payer: Cigna of WY Commercial |
$639.94
|
| Rate for Payer: Entrust Commercial |
$620.35
|
| Rate for Payer: First Choice Health Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$620.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.21
|
| Rate for Payer: HealthUtah PPO |
$653.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$633.41
|
| Rate for Payer: Multiplan Medicare/VA |
$353.60
|
| Rate for Payer: One Health Plan of WY PPO |
$639.94
|
| Rate for Payer: PacificSource Commercial |
$587.70
|
| Rate for Payer: PHCS PPO |
$639.94
|
| Rate for Payer: Three Rivers PPO |
$489.75
|
| Rate for Payer: TriWest Veterans Administration |
$372.21
|
| Rate for Payer: United Healthcare Commercial |
$623.62
|
| Rate for Payer: United Healthcare Medicare |
$372.21
|
| Rate for Payer: WINHealth Partners Commercial |
$639.94
|
| Rate for Payer: Wise Provider Network Commercial |
$620.35
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7612061101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
4022061101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$487.94 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$825.16
|
| Rate for Payer: Aetna of WY Medicare |
$538.88
|
| Rate for Payer: Altius Commercial |
$808.32
|
| Rate for Payer: Beech Street Commercial |
$825.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$816.74
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$816.74
|
| Rate for Payer: Cigna of WY Commercial |
$825.16
|
| Rate for Payer: Entrust Commercial |
$799.90
|
| Rate for Payer: First Choice Health Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$513.62
|
| Rate for Payer: HealthUtah PPO |
$842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$816.74
|
| Rate for Payer: Multiplan Medicare/VA |
$487.94
|
| Rate for Payer: One Health Plan of WY PPO |
$825.16
|
| Rate for Payer: PacificSource Commercial |
$757.80
|
| Rate for Payer: PHCS PPO |
$825.16
|
| Rate for Payer: Three Rivers PPO |
$631.50
|
| Rate for Payer: TriWest Veterans Administration |
$513.62
|
| Rate for Payer: United Healthcare Commercial |
$804.11
|
| Rate for Payer: United Healthcare Medicare |
$513.62
|
| Rate for Payer: WINHealth Partners Commercial |
$799.90
|
| Rate for Payer: Wise Provider Network Commercial |
$799.90
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
4022061101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$455.94 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$825.16
|
| Rate for Payer: Aetna of WY Medicare |
$555.72
|
| Rate for Payer: Altius Commercial |
$808.32
|
| Rate for Payer: Beech Street Commercial |
$825.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$816.74
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$816.74
|
| Rate for Payer: Cigna of WY Commercial |
$825.16
|
| Rate for Payer: Entrust Commercial |
$799.90
|
| Rate for Payer: First Choice Health Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$479.94
|
| Rate for Payer: HealthUtah PPO |
$842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$816.74
|
| Rate for Payer: Multiplan Medicare/VA |
$455.94
|
| Rate for Payer: One Health Plan of WY PPO |
$825.16
|
| Rate for Payer: PacificSource Commercial |
$757.80
|
| Rate for Payer: PHCS PPO |
$825.16
|
| Rate for Payer: Three Rivers PPO |
$631.50
|
| Rate for Payer: TriWest Veterans Administration |
$479.94
|
| Rate for Payer: United Healthcare Commercial |
$804.11
|
| Rate for Payer: United Healthcare Medicare |
$479.94
|
| Rate for Payer: WINHealth Partners Commercial |
$825.16
|
| Rate for Payer: Wise Provider Network Commercial |
$799.90
|
|
|
HC ARTHROCENTESIS ASPIR INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7612061101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
7612060001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3522060001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$450.53 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$815.36
|
| Rate for Payer: Aetna of WY Medicare |
$549.12
|
| Rate for Payer: Altius Commercial |
$798.72
|
| Rate for Payer: Beech Street Commercial |
$815.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$807.04
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$807.04
|
| Rate for Payer: Cigna of WY Commercial |
$815.36
|
| Rate for Payer: Entrust Commercial |
$790.40
|
| Rate for Payer: First Choice Health Commercial |
$790.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$790.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$474.24
|
| Rate for Payer: HealthUtah PPO |
$832.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$807.04
|
| Rate for Payer: Multiplan Medicare/VA |
$450.53
|
| Rate for Payer: One Health Plan of WY PPO |
$815.36
|
| Rate for Payer: PacificSource Commercial |
$748.80
|
| Rate for Payer: PHCS PPO |
$815.36
|
| Rate for Payer: Three Rivers PPO |
$624.00
|
| Rate for Payer: TriWest Veterans Administration |
$474.24
|
| Rate for Payer: United Healthcare Commercial |
$794.56
|
| Rate for Payer: United Healthcare Medicare |
$474.24
|
| Rate for Payer: WINHealth Partners Commercial |
$815.36
|
| Rate for Payer: Wise Provider Network Commercial |
$790.40
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3522060001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$482.14 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$815.36
|
| Rate for Payer: Aetna of WY Medicare |
$532.48
|
| Rate for Payer: Altius Commercial |
$798.72
|
| Rate for Payer: Beech Street Commercial |
$815.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$807.04
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$807.04
|
| Rate for Payer: Cigna of WY Commercial |
$815.36
|
| Rate for Payer: Entrust Commercial |
$790.40
|
| Rate for Payer: First Choice Health Commercial |
$790.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$790.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.52
|
| Rate for Payer: HealthUtah PPO |
$832.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$807.04
|
| Rate for Payer: Multiplan Medicare/VA |
$482.14
|
| Rate for Payer: One Health Plan of WY PPO |
$815.36
|
| Rate for Payer: PacificSource Commercial |
$748.80
|
| Rate for Payer: PHCS PPO |
$815.36
|
| Rate for Payer: Three Rivers PPO |
$624.00
|
| Rate for Payer: TriWest Veterans Administration |
$507.52
|
| Rate for Payer: United Healthcare Commercial |
$794.56
|
| Rate for Payer: United Healthcare Medicare |
$507.52
|
| Rate for Payer: WINHealth Partners Commercial |
$790.40
|
| Rate for Payer: Wise Provider Network Commercial |
$790.40
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
7612060001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3202060001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$432.89 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$732.06
|
| Rate for Payer: Aetna of WY Medicare |
$478.08
|
| Rate for Payer: Altius Commercial |
$717.12
|
| Rate for Payer: Beech Street Commercial |
$732.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$724.59
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$724.59
|
| Rate for Payer: Cigna of WY Commercial |
$732.06
|
| Rate for Payer: Entrust Commercial |
$709.65
|
| Rate for Payer: First Choice Health Commercial |
$709.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$709.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.67
|
| Rate for Payer: HealthUtah PPO |
$747.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$724.59
|
| Rate for Payer: Multiplan Medicare/VA |
$432.89
|
| Rate for Payer: One Health Plan of WY PPO |
$732.06
|
| Rate for Payer: PacificSource Commercial |
$672.30
|
| Rate for Payer: PHCS PPO |
$732.06
|
| Rate for Payer: Three Rivers PPO |
$560.25
|
| Rate for Payer: TriWest Veterans Administration |
$455.67
|
| Rate for Payer: United Healthcare Commercial |
$713.38
|
| Rate for Payer: United Healthcare Medicare |
$455.67
|
| Rate for Payer: WINHealth Partners Commercial |
$709.65
|
| Rate for Payer: Wise Provider Network Commercial |
$709.65
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
3202060001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$732.06
|
| Rate for Payer: Aetna of WY Medicare |
$493.02
|
| Rate for Payer: Altius Commercial |
$717.12
|
| Rate for Payer: Beech Street Commercial |
$732.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$724.59
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$724.59
|
| Rate for Payer: Cigna of WY Commercial |
$732.06
|
| Rate for Payer: Entrust Commercial |
$709.65
|
| Rate for Payer: First Choice Health Commercial |
$709.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$709.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$425.79
|
| Rate for Payer: HealthUtah PPO |
$747.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$724.59
|
| Rate for Payer: Multiplan Medicare/VA |
$404.50
|
| Rate for Payer: One Health Plan of WY PPO |
$732.06
|
| Rate for Payer: PacificSource Commercial |
$672.30
|
| Rate for Payer: PHCS PPO |
$732.06
|
| Rate for Payer: Three Rivers PPO |
$560.25
|
| Rate for Payer: TriWest Veterans Administration |
$425.79
|
| Rate for Payer: United Healthcare Commercial |
$713.38
|
| Rate for Payer: United Healthcare Medicare |
$425.79
|
| Rate for Payer: WINHealth Partners Commercial |
$732.06
|
| Rate for Payer: Wise Provider Network Commercial |
$709.65
|
|
|
HC ARTHROCNT ASPIR INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
4022060401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$668.21 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,209.32
|
| Rate for Payer: Aetna of WY Medicare |
$814.44
|
| Rate for Payer: Altius Commercial |
$1,184.64
|
| Rate for Payer: Beech Street Commercial |
$1,209.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,196.98
|
| Rate for Payer: Cash Price |
$863.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,196.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,209.32
|
| Rate for Payer: Entrust Commercial |
$1,172.30
|
| Rate for Payer: First Choice Health Commercial |
$1,172.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,172.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$703.38
|
| Rate for Payer: HealthUtah PPO |
$1,234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,196.98
|
| Rate for Payer: Multiplan Medicare/VA |
$668.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,209.32
|
| Rate for Payer: PacificSource Commercial |
$1,110.60
|
| Rate for Payer: PHCS PPO |
$1,209.32
|
| Rate for Payer: Three Rivers PPO |
$925.50
|
| Rate for Payer: TriWest Veterans Administration |
$703.38
|
| Rate for Payer: United Healthcare Commercial |
$1,178.47
|
| Rate for Payer: United Healthcare Medicare |
$703.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,209.32
|
| Rate for Payer: Wise Provider Network Commercial |
$1,172.30
|
|
