|
HC INJ,ANES AGENT,SCIATIC NERVE,SINGLE
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
5106444501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$304.15 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$364.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$529.92
|
| Rate for Payer: Altius Commercial |
$529.92
|
| Rate for Payer: Beech Street Commercial |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$453.19
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: Entrust Commercial |
$524.40
|
| Rate for Payer: First Choice Health Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.16
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$304.15
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$540.96
|
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.16
|
| Rate for Payer: United Healthcare Commercial |
$480.24
|
| Rate for Payer: United Healthcare Medicare |
$320.16
|
| Rate for Payer: WINHealth Partners Commercial |
$540.96
|
| Rate for Payer: Wise Provider Network Commercial |
$524.40
|
|
|
HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
3206449001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,204.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,920.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,640.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,840.00
|
| Rate for Payer: Altius Commercial |
$3,840.00
|
| Rate for Payer: Beech Street Commercial |
$3,920.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,880.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,920.00
|
| Rate for Payer: Entrust Commercial |
$3,800.00
|
| Rate for Payer: First Choice Health Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,320.00
|
| Rate for Payer: HealthUtah PPO |
$4,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,880.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,204.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,920.00
|
| Rate for Payer: PacificSource Commercial |
$3,600.00
|
| Rate for Payer: PHCS PPO |
$3,920.00
|
| Rate for Payer: Three Rivers PPO |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,320.00
|
| Rate for Payer: United Healthcare Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare Medicare |
$2,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,920.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,800.00
|
|
|
HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
3206449001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,508.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,920.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,840.00
|
| Rate for Payer: Altius Commercial |
$3,840.00
|
| Rate for Payer: Beech Street Commercial |
$3,920.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,880.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,920.00
|
| Rate for Payer: Entrust Commercial |
$3,800.00
|
| Rate for Payer: First Choice Health Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,640.00
|
| Rate for Payer: HealthUtah PPO |
$4,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,880.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,508.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,920.00
|
| Rate for Payer: PacificSource Commercial |
$3,600.00
|
| Rate for Payer: PHCS PPO |
$3,920.00
|
| Rate for Payer: Three Rivers PPO |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,640.00
|
| Rate for Payer: United Healthcare Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare Medicare |
$2,640.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,800.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,800.00
|
|
|
HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LEVEL
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
3206449301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,508.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,920.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,840.00
|
| Rate for Payer: Altius Commercial |
$3,840.00
|
| Rate for Payer: Beech Street Commercial |
$3,920.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,880.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,920.00
|
| Rate for Payer: Entrust Commercial |
$3,800.00
|
| Rate for Payer: First Choice Health Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,640.00
|
| Rate for Payer: HealthUtah PPO |
$4,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,880.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,508.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,920.00
|
| Rate for Payer: PacificSource Commercial |
$3,600.00
|
| Rate for Payer: PHCS PPO |
$3,920.00
|
| Rate for Payer: Three Rivers PPO |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,640.00
|
| Rate for Payer: United Healthcare Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare Medicare |
$2,640.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,800.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,800.00
|
|
|
HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,LUMBAR/SAC, 1ST LEVEL
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
3206449301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,204.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,920.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,640.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,840.00
|
| Rate for Payer: Altius Commercial |
$3,840.00
|
| Rate for Payer: Beech Street Commercial |
$3,920.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,284.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,880.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,920.00
|
| Rate for Payer: Entrust Commercial |
$3,800.00
|
| Rate for Payer: First Choice Health Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,800.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,320.00
|
| Rate for Payer: HealthUtah PPO |
$4,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,880.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,204.00
|
| Rate for Payer: One Health Plan of WY PPO |
$3,920.00
|
| Rate for Payer: PacificSource Commercial |
$3,600.00
|
| Rate for Payer: PHCS PPO |
$3,920.00
|
| Rate for Payer: Three Rivers PPO |
$3,000.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,320.00
|
| Rate for Payer: United Healthcare Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare Medicare |
$2,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,920.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,800.00
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Facility
|
OP
|
$2,715.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
3206448301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,495.96 |
| Max. Negotiated Rate |
$2,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,660.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,791.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,606.40
|
| Rate for Payer: Altius Commercial |
$2,606.40
|
| Rate for Payer: Beech Street Commercial |
$2,660.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,229.02
|
| Rate for Payer: Cash Price |
$1,900.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,633.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,660.70
|
| Rate for Payer: Entrust Commercial |
$2,579.25
|
| Rate for Payer: First Choice Health Commercial |
$2,579.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,579.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,574.70
|
| Rate for Payer: HealthUtah PPO |
$2,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,633.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,495.96
|
| Rate for Payer: One Health Plan of WY PPO |
$2,660.70
|
| Rate for Payer: PacificSource Commercial |
$2,443.50
|
| Rate for Payer: PHCS PPO |
$2,660.70
|
| Rate for Payer: Three Rivers PPO |
$2,036.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,574.70
|
| Rate for Payer: United Healthcare Commercial |
$2,362.05
|
| Rate for Payer: United Healthcare Medicare |
$1,574.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,660.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,579.25
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Facility
|
IP
|
$2,715.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
3206448301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,702.30 |
| Max. Negotiated Rate |
$2,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,660.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,606.40
|
| Rate for Payer: Altius Commercial |
$2,606.40
|
| Rate for Payer: Beech Street Commercial |
$2,660.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,229.02
|
| Rate for Payer: Cash Price |
$1,900.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,633.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,660.70
|
| Rate for Payer: Entrust Commercial |
$2,579.25
|
| Rate for Payer: First Choice Health Commercial |
$2,579.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,579.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,791.90
|
| Rate for Payer: HealthUtah PPO |
$2,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,633.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,702.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,660.70
|
| Rate for Payer: PacificSource Commercial |
$2,443.50
|
| Rate for Payer: PHCS PPO |
$2,660.70
|
| Rate for Payer: Three Rivers PPO |
$2,036.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,791.90
|
| Rate for Payer: United Healthcare Commercial |
$2,362.05
|
| Rate for Payer: United Healthcare Medicare |
$1,791.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,579.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,579.25
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
3506448301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,187.40 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Aetna of WY Medicare |
$1,422.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,068.80
|
| Rate for Payer: Altius Commercial |
$2,068.80
|
| Rate for Payer: Beech Street Commercial |
$2,111.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,769.26
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: Entrust Commercial |
$2,047.25
|
| Rate for Payer: First Choice Health Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,249.90
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,187.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,111.90
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,249.90
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$1,249.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,111.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,047.25
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
3506448301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,351.18 |
| Max. Negotiated Rate |
$2,155.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,111.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,068.80
|
| Rate for Payer: Altius Commercial |
$2,068.80
|
| Rate for Payer: Beech Street Commercial |
$2,111.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,769.26
|
| Rate for Payer: Cash Price |
$1,508.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,090.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,111.90
|
| Rate for Payer: Entrust Commercial |
$2,047.25
|
| Rate for Payer: First Choice Health Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,047.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,422.30
|
| Rate for Payer: HealthUtah PPO |
$2,155.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,090.35
|
| Rate for Payer: Multiplan Medicare/VA |
$1,351.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,111.90
|
| Rate for Payer: PacificSource Commercial |
$1,939.50
|
| Rate for Payer: PHCS PPO |
$2,111.90
|
| Rate for Payer: Three Rivers PPO |
$1,616.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,422.30
|
| Rate for Payer: United Healthcare Commercial |
$1,874.85
|
| Rate for Payer: United Healthcare Medicare |
$1,422.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,047.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,047.25
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
HCPCS 64484 50
|
| Hospital Charge Code |
3206448401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,993.86 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,116.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,052.80
|
| Rate for Payer: Altius Commercial |
$3,052.80
|
| Rate for Payer: Beech Street Commercial |
$3,116.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,610.78
|
| Rate for Payer: Cash Price |
$2,226.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,084.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,116.40
|
| Rate for Payer: Entrust Commercial |
$3,021.00
|
| Rate for Payer: First Choice Health Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,098.80
|
| Rate for Payer: HealthUtah PPO |
$3,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,084.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,993.86
|
| Rate for Payer: One Health Plan of WY PPO |
$3,116.40
|
| Rate for Payer: PacificSource Commercial |
$2,862.00
|
| Rate for Payer: PHCS PPO |
$3,116.40
|
| Rate for Payer: Three Rivers PPO |
$2,385.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,098.80
|
| Rate for Payer: United Healthcare Commercial |
$2,766.60
|
| Rate for Payer: United Healthcare Medicare |
$2,098.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,021.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,021.00
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
HCPCS 64484
|
| Hospital Charge Code |
3206448401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,993.86 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,116.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,052.80
|
| Rate for Payer: Altius Commercial |
$3,052.80
|
| Rate for Payer: Beech Street Commercial |
$3,116.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,610.78
|
| Rate for Payer: Cash Price |
$2,226.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,084.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,116.40
|
| Rate for Payer: Entrust Commercial |
$3,021.00
|
| Rate for Payer: First Choice Health Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,098.80
|
| Rate for Payer: HealthUtah PPO |
$3,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,084.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,993.86
|
| Rate for Payer: One Health Plan of WY PPO |
$3,116.40
|
| Rate for Payer: PacificSource Commercial |
$2,862.00
|
| Rate for Payer: PHCS PPO |
$3,116.40
|
| Rate for Payer: Three Rivers PPO |
$2,385.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,098.80
|
| Rate for Payer: United Healthcare Commercial |
$2,766.60
|
| Rate for Payer: United Healthcare Medicare |
$2,098.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,021.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,021.00
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
HCPCS 64484 50
|
| Hospital Charge Code |
3206448401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,752.18 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,116.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,098.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,052.80
|
| Rate for Payer: Altius Commercial |
$3,052.80
|
| Rate for Payer: Beech Street Commercial |
$3,116.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,610.78
|
| Rate for Payer: Cash Price |
$2,226.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,084.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,116.40
|
| Rate for Payer: Entrust Commercial |
$3,021.00
|
| Rate for Payer: First Choice Health Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,844.40
|
| Rate for Payer: HealthUtah PPO |
$3,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,084.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,752.18
|
| Rate for Payer: One Health Plan of WY PPO |
$3,116.40
|
| Rate for Payer: PacificSource Commercial |
$2,862.00
|
| Rate for Payer: PHCS PPO |
$3,116.40
|
| Rate for Payer: Three Rivers PPO |
$2,385.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,844.40
|
| Rate for Payer: United Healthcare Commercial |
$2,766.60
|
| Rate for Payer: United Healthcare Medicare |
$1,844.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,116.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,021.00
|
|
|
HC INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
HCPCS 64484
|
| Hospital Charge Code |
3206448401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,752.18 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,116.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,098.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,052.80
|
| Rate for Payer: Altius Commercial |
$3,052.80
|
| Rate for Payer: Beech Street Commercial |
$3,116.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,610.78
|
| Rate for Payer: Cash Price |
$2,226.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,084.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,116.40
|
| Rate for Payer: Entrust Commercial |
$3,021.00
|
| Rate for Payer: First Choice Health Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,021.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,844.40
|
| Rate for Payer: HealthUtah PPO |
$3,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,084.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,752.18
|
| Rate for Payer: One Health Plan of WY PPO |
$3,116.40
|
| Rate for Payer: PacificSource Commercial |
$2,862.00
|
| Rate for Payer: PHCS PPO |
$3,116.40
|
| Rate for Payer: Three Rivers PPO |
$2,385.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,844.40
|
| Rate for Payer: United Healthcare Commercial |
$2,766.60
|
| Rate for Payer: United Healthcare Medicare |
$1,844.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,116.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,021.00
|
|
|
HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
HCPCS 64455 50
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.47 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$343.68
|
| Rate for Payer: Altius Commercial |
$343.68
|
| Rate for Payer: Beech Street Commercial |
$350.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.92
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: Entrust Commercial |
$340.10
|
| Rate for Payer: First Choice Health Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$236.28
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Multiplan Medicare/VA |
$224.47
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$350.84
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: TriWest Veterans Administration |
$236.28
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$236.28
|
| Rate for Payer: WINHealth Partners Commercial |
$340.10
|
| Rate for Payer: Wise Provider Network Commercial |
$340.10
|
|
|
HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.84
|
| Rate for Payer: Altius Commercial |
$171.84
|
| Rate for Payer: Beech Street Commercial |
$175.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.96
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.63
|
| Rate for Payer: Cigna of WY Commercial |
$175.42
|
| Rate for Payer: Entrust Commercial |
$170.05
|
| Rate for Payer: First Choice Health Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.14
|
| Rate for Payer: HealthUtah PPO |
$179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.63
|
| Rate for Payer: Multiplan Medicare/VA |
$112.23
|
| Rate for Payer: One Health Plan of WY PPO |
$175.42
|
| Rate for Payer: PacificSource Commercial |
$161.10
|
| Rate for Payer: PHCS PPO |
$175.42
|
| Rate for Payer: Three Rivers PPO |
$134.25
|
| Rate for Payer: TriWest Veterans Administration |
$118.14
|
| Rate for Payer: United Healthcare Commercial |
$155.73
|
| Rate for Payer: United Healthcare Medicare |
$118.14
|
| Rate for Payer: WINHealth Partners Commercial |
$170.05
|
| Rate for Payer: Wise Provider Network Commercial |
$170.05
|
|
|
HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$175.42
|
| Rate for Payer: Aetna of WY Medicare |
$118.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.84
|
| Rate for Payer: Altius Commercial |
$171.84
|
| Rate for Payer: Beech Street Commercial |
$175.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.96
|
| Rate for Payer: Cash Price |
$125.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.63
|
| Rate for Payer: Cigna of WY Commercial |
$175.42
|
| Rate for Payer: Entrust Commercial |
$170.05
|
| Rate for Payer: First Choice Health Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.82
|
| Rate for Payer: HealthUtah PPO |
$179.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.63
|
| Rate for Payer: Multiplan Medicare/VA |
$98.63
|
| Rate for Payer: One Health Plan of WY PPO |
$175.42
|
| Rate for Payer: PacificSource Commercial |
$161.10
|
| Rate for Payer: PHCS PPO |
$175.42
|
| Rate for Payer: Three Rivers PPO |
$134.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.82
|
| Rate for Payer: United Healthcare Commercial |
$155.73
|
| Rate for Payer: United Healthcare Medicare |
$103.82
|
| Rate for Payer: WINHealth Partners Commercial |
$175.42
|
| Rate for Payer: Wise Provider Network Commercial |
$170.05
|
|
|
HC INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
HCPCS 64455 50
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.26 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Aetna of WY Medicare |
$236.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$343.68
|
| Rate for Payer: Altius Commercial |
$343.68
|
| Rate for Payer: Beech Street Commercial |
$350.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.92
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: Entrust Commercial |
$340.10
|
| Rate for Payer: First Choice Health Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.64
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Multiplan Medicare/VA |
$197.26
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$350.84
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: TriWest Veterans Administration |
$207.64
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$207.64
|
| Rate for Payer: WINHealth Partners Commercial |
$350.84
|
| Rate for Payer: Wise Provider Network Commercial |
$340.10
|
|
|
HC INJECTION ANKLE ARTHROGRAPHY LT
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
3202764801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$834.76 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,484.70
|
| Rate for Payer: Aetna of WY Medicare |
$999.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,454.40
|
| Rate for Payer: Altius Commercial |
$1,454.40
|
| Rate for Payer: Beech Street Commercial |
$1,484.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,243.82
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,469.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,484.70
|
| Rate for Payer: Entrust Commercial |
$1,439.25
|
| Rate for Payer: First Choice Health Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.70
|
| Rate for Payer: HealthUtah PPO |
$1,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,469.55
|
| Rate for Payer: Multiplan Medicare/VA |
$834.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,484.70
|
| Rate for Payer: PacificSource Commercial |
$1,363.50
|
| Rate for Payer: PHCS PPO |
$1,484.70
|
| Rate for Payer: Three Rivers PPO |
$1,136.25
|
| Rate for Payer: TriWest Veterans Administration |
$878.70
|
| Rate for Payer: United Healthcare Commercial |
$1,318.05
|
| Rate for Payer: United Healthcare Medicare |
$878.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,484.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,439.25
|
|
|
HC INJECTION ANKLE ARTHROGRAPHY LT
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
3202764801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$949.90 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,484.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,454.40
|
| Rate for Payer: Altius Commercial |
$1,454.40
|
| Rate for Payer: Beech Street Commercial |
$1,484.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,243.82
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,469.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,484.70
|
| Rate for Payer: Entrust Commercial |
$1,439.25
|
| Rate for Payer: First Choice Health Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$999.90
|
| Rate for Payer: HealthUtah PPO |
$1,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,469.55
|
| Rate for Payer: Multiplan Medicare/VA |
$949.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,484.70
|
| Rate for Payer: PacificSource Commercial |
$1,363.50
|
| Rate for Payer: PHCS PPO |
$1,484.70
|
| Rate for Payer: Three Rivers PPO |
$1,136.25
|
| Rate for Payer: TriWest Veterans Administration |
$999.90
|
| Rate for Payer: United Healthcare Commercial |
$1,318.05
|
| Rate for Payer: United Healthcare Medicare |
$999.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,439.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,439.25
|
|
|
HC INJECTION ANKLE ARTHROGRAPHY RT
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
3202764802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$949.90 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,484.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,454.40
|
| Rate for Payer: Altius Commercial |
$1,454.40
|
| Rate for Payer: Beech Street Commercial |
$1,484.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,243.82
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,469.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,484.70
|
| Rate for Payer: Entrust Commercial |
$1,439.25
|
| Rate for Payer: First Choice Health Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$999.90
|
| Rate for Payer: HealthUtah PPO |
$1,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,469.55
|
| Rate for Payer: Multiplan Medicare/VA |
$949.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,484.70
|
| Rate for Payer: PacificSource Commercial |
$1,363.50
|
| Rate for Payer: PHCS PPO |
$1,484.70
|
| Rate for Payer: Three Rivers PPO |
$1,136.25
|
| Rate for Payer: TriWest Veterans Administration |
$999.90
|
| Rate for Payer: United Healthcare Commercial |
$1,318.05
|
| Rate for Payer: United Healthcare Medicare |
$999.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,439.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,439.25
|
|
|
HC INJECTION ANKLE ARTHROGRAPHY RT
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
3202764802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$834.76 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,484.70
|
| Rate for Payer: Aetna of WY Medicare |
$999.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,454.40
|
| Rate for Payer: Altius Commercial |
$1,454.40
|
| Rate for Payer: Beech Street Commercial |
$1,484.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,243.82
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,469.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,484.70
|
| Rate for Payer: Entrust Commercial |
$1,439.25
|
| Rate for Payer: First Choice Health Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,439.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$878.70
|
| Rate for Payer: HealthUtah PPO |
$1,515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,469.55
|
| Rate for Payer: Multiplan Medicare/VA |
$834.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,484.70
|
| Rate for Payer: PacificSource Commercial |
$1,363.50
|
| Rate for Payer: PHCS PPO |
$1,484.70
|
| Rate for Payer: Three Rivers PPO |
$1,136.25
|
| Rate for Payer: TriWest Veterans Administration |
$878.70
|
| Rate for Payer: United Healthcare Commercial |
$1,318.05
|
| Rate for Payer: United Healthcare Medicare |
$878.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,484.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,439.25
|
|
|
HC INJECTION ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 20527
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.36
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.56
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$41.38
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$43.56
|
| Rate for Payer: WINHealth Partners Commercial |
$62.70
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC INJECTION ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 20527 50
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.12
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$82.76
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.12
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$87.12
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
|
HC INJECTION ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 20527
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$64.68
|
| Rate for Payer: Aetna of WY Medicare |
$43.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.36
|
| Rate for Payer: Altius Commercial |
$63.36
|
| Rate for Payer: Beech Street Commercial |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.19
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.02
|
| Rate for Payer: Cigna of WY Commercial |
$64.68
|
| Rate for Payer: Entrust Commercial |
$62.70
|
| Rate for Payer: First Choice Health Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$62.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$66.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.02
|
| Rate for Payer: Multiplan Medicare/VA |
$36.37
|
| Rate for Payer: One Health Plan of WY PPO |
$64.68
|
| Rate for Payer: PacificSource Commercial |
$59.40
|
| Rate for Payer: PHCS PPO |
$64.68
|
| Rate for Payer: Three Rivers PPO |
$49.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$57.42
|
| Rate for Payer: United Healthcare Medicare |
$38.28
|
| Rate for Payer: WINHealth Partners Commercial |
$64.68
|
| Rate for Payer: Wise Provider Network Commercial |
$62.70
|
|
|
HC INJECTION ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 20527 50
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$87.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.56
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$72.73
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$76.56
|
| Rate for Payer: WINHealth Partners Commercial |
$129.36
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
