|
HC INJECTION FOR ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
3202422001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,102.50
|
| Rate for Payer: Aetna of WY Medicare |
$742.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,080.00
|
| Rate for Payer: Altius Commercial |
$1,080.00
|
| Rate for Payer: Beech Street Commercial |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$923.62
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,091.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,102.50
|
| Rate for Payer: Entrust Commercial |
$1,068.75
|
| Rate for Payer: First Choice Health Commercial |
$1,068.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,068.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$652.50
|
| Rate for Payer: HealthUtah PPO |
$1,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,091.25
|
| Rate for Payer: Multiplan Medicare/VA |
$619.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,102.50
|
| Rate for Payer: PacificSource Commercial |
$1,012.50
|
| Rate for Payer: PHCS PPO |
$1,102.50
|
| Rate for Payer: Three Rivers PPO |
$843.75
|
| Rate for Payer: TriWest Veterans Administration |
$652.50
|
| Rate for Payer: United Healthcare Commercial |
$978.75
|
| Rate for Payer: United Healthcare Medicare |
$652.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,102.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,068.75
|
|
|
HC INJECTION FOR ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
3202422001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$705.38 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,102.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,080.00
|
| Rate for Payer: Altius Commercial |
$1,080.00
|
| Rate for Payer: Beech Street Commercial |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$923.62
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,091.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,102.50
|
| Rate for Payer: Entrust Commercial |
$1,068.75
|
| Rate for Payer: First Choice Health Commercial |
$1,068.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,068.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$742.50
|
| Rate for Payer: HealthUtah PPO |
$1,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,091.25
|
| Rate for Payer: Multiplan Medicare/VA |
$705.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,102.50
|
| Rate for Payer: PacificSource Commercial |
$1,012.50
|
| Rate for Payer: PHCS PPO |
$1,102.50
|
| Rate for Payer: Three Rivers PPO |
$843.75
|
| Rate for Payer: TriWest Veterans Administration |
$742.50
|
| Rate for Payer: United Healthcare Commercial |
$978.75
|
| Rate for Payer: United Healthcare Medicare |
$742.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,068.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,068.75
|
|
|
HC INJECTION FOR WRIST ARTHROGRAM
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
3612524601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.54 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Aetna of WY Medicare |
$518.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.30
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$432.54
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$455.30
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$455.30
|
| Rate for Payer: WINHealth Partners Commercial |
$769.30
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC INJECTION FOR WRIST ARTHROGRAM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
3202524601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$451.82 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$803.60
|
| Rate for Payer: Aetna of WY Medicare |
$541.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$787.20
|
| Rate for Payer: Altius Commercial |
$787.20
|
| Rate for Payer: Beech Street Commercial |
$803.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$673.22
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$795.40
|
| Rate for Payer: Cigna of WY Commercial |
$803.60
|
| Rate for Payer: Entrust Commercial |
$779.00
|
| Rate for Payer: First Choice Health Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.60
|
| Rate for Payer: HealthUtah PPO |
$820.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$795.40
|
| Rate for Payer: Multiplan Medicare/VA |
$451.82
|
| Rate for Payer: One Health Plan of WY PPO |
$803.60
|
| Rate for Payer: PacificSource Commercial |
$738.00
|
| Rate for Payer: PHCS PPO |
$803.60
|
| Rate for Payer: Three Rivers PPO |
$615.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.60
|
| Rate for Payer: United Healthcare Commercial |
$713.40
|
| Rate for Payer: United Healthcare Medicare |
$475.60
|
| Rate for Payer: WINHealth Partners Commercial |
$803.60
|
| Rate for Payer: Wise Provider Network Commercial |
$779.00
|
|
|
HC INJECTION FOR WRIST ARTHROGRAM
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
3612524601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$518.10
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$492.20
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$518.10
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$518.10
|
| Rate for Payer: WINHealth Partners Commercial |
$745.75
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC INJECTION FOR WRIST ARTHROGRAM
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
3202524601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.14 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$803.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$787.20
|
| Rate for Payer: Altius Commercial |
$787.20
|
| Rate for Payer: Beech Street Commercial |
$803.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$673.22
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$795.40
|
| Rate for Payer: Cigna of WY Commercial |
$803.60
|
| Rate for Payer: Entrust Commercial |
$779.00
|
| Rate for Payer: First Choice Health Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.20
|
| Rate for Payer: HealthUtah PPO |
$820.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$795.40
|
| Rate for Payer: Multiplan Medicare/VA |
$514.14
|
| Rate for Payer: One Health Plan of WY PPO |
$803.60
|
| Rate for Payer: PacificSource Commercial |
$738.00
|
| Rate for Payer: PHCS PPO |
$803.60
|
| Rate for Payer: Three Rivers PPO |
$615.00
|
| Rate for Payer: TriWest Veterans Administration |
$541.20
|
| Rate for Payer: United Healthcare Commercial |
$713.40
|
| Rate for Payer: United Healthcare Medicare |
$541.20
|
| Rate for Payer: WINHealth Partners Commercial |
$779.00
|
| Rate for Payer: Wise Provider Network Commercial |
$779.00
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
3202709301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$413.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Aetna of WY Medicare |
$495.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$435.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$413.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$435.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$435.00
|
| Rate for Payer: WINHealth Partners Commercial |
$735.00
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
3202709301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$735.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$720.00
|
| Rate for Payer: Altius Commercial |
$720.00
|
| Rate for Payer: Beech Street Commercial |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$615.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$727.50
|
| Rate for Payer: Cigna of WY Commercial |
$735.00
|
| Rate for Payer: Entrust Commercial |
$712.50
|
| Rate for Payer: First Choice Health Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$712.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.00
|
| Rate for Payer: HealthUtah PPO |
$750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$727.50
|
| Rate for Payer: Multiplan Medicare/VA |
$470.25
|
| Rate for Payer: One Health Plan of WY PPO |
$735.00
|
| Rate for Payer: PacificSource Commercial |
$675.00
|
| Rate for Payer: PHCS PPO |
$735.00
|
| Rate for Payer: Three Rivers PPO |
$562.50
|
| Rate for Payer: TriWest Veterans Administration |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicare |
$495.00
|
| Rate for Payer: WINHealth Partners Commercial |
$712.50
|
| Rate for Payer: Wise Provider Network Commercial |
$712.50
|
|
|
HC INJECTION INTRALESIONAL 1-7 LESIONS
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
5101190001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC INJECTION INTRALESIONAL 1-7 LESIONS
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
5101190001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC INJECTION KNEE ARTHROGRAPHY LT
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 27370
|
| Hospital Charge Code |
3202737002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$476.62 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$847.70
|
| Rate for Payer: Aetna of WY Medicare |
$570.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$830.40
|
| Rate for Payer: Altius Commercial |
$830.40
|
| Rate for Payer: Beech Street Commercial |
$847.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$710.16
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$839.05
|
| Rate for Payer: Cigna of WY Commercial |
$847.70
|
| Rate for Payer: Entrust Commercial |
$821.75
|
| Rate for Payer: First Choice Health Commercial |
$821.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$821.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.70
|
| Rate for Payer: HealthUtah PPO |
$865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$839.05
|
| Rate for Payer: Multiplan Medicare/VA |
$476.62
|
| Rate for Payer: One Health Plan of WY PPO |
$847.70
|
| Rate for Payer: PacificSource Commercial |
$778.50
|
| Rate for Payer: PHCS PPO |
$847.70
|
| Rate for Payer: Three Rivers PPO |
$648.75
|
| Rate for Payer: TriWest Veterans Administration |
$501.70
|
| Rate for Payer: United Healthcare Commercial |
$752.55
|
| Rate for Payer: United Healthcare Medicare |
$501.70
|
| Rate for Payer: WINHealth Partners Commercial |
$847.70
|
| Rate for Payer: Wise Provider Network Commercial |
$821.75
|
|
|
HC INJECTION KNEE ARTHROGRAPHY LT
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 27370
|
| Hospital Charge Code |
3202737002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$542.36 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$847.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$830.40
|
| Rate for Payer: Altius Commercial |
$830.40
|
| Rate for Payer: Beech Street Commercial |
$847.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$710.16
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$839.05
|
| Rate for Payer: Cigna of WY Commercial |
$847.70
|
| Rate for Payer: Entrust Commercial |
$821.75
|
| Rate for Payer: First Choice Health Commercial |
$821.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$821.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$570.90
|
| Rate for Payer: HealthUtah PPO |
$865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$839.05
|
| Rate for Payer: Multiplan Medicare/VA |
$542.36
|
| Rate for Payer: One Health Plan of WY PPO |
$847.70
|
| Rate for Payer: PacificSource Commercial |
$778.50
|
| Rate for Payer: PHCS PPO |
$847.70
|
| Rate for Payer: Three Rivers PPO |
$648.75
|
| Rate for Payer: TriWest Veterans Administration |
$570.90
|
| Rate for Payer: United Healthcare Commercial |
$752.55
|
| Rate for Payer: United Healthcare Medicare |
$570.90
|
| Rate for Payer: WINHealth Partners Commercial |
$821.75
|
| Rate for Payer: Wise Provider Network Commercial |
$821.75
|
|
|
HC INJECTION KNEE ARTHROGRAPHY RT
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
HCPCS 27370
|
| Hospital Charge Code |
3202737001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$545.49 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$970.20
|
| Rate for Payer: Aetna of WY Medicare |
$653.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$950.40
|
| Rate for Payer: Altius Commercial |
$950.40
|
| Rate for Payer: Beech Street Commercial |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.79
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$960.30
|
| Rate for Payer: Cigna of WY Commercial |
$970.20
|
| Rate for Payer: Entrust Commercial |
$940.50
|
| Rate for Payer: First Choice Health Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$574.20
|
| Rate for Payer: HealthUtah PPO |
$990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$960.30
|
| Rate for Payer: Multiplan Medicare/VA |
$545.49
|
| Rate for Payer: One Health Plan of WY PPO |
$970.20
|
| Rate for Payer: PacificSource Commercial |
$891.00
|
| Rate for Payer: PHCS PPO |
$970.20
|
| Rate for Payer: Three Rivers PPO |
$742.50
|
| Rate for Payer: TriWest Veterans Administration |
$574.20
|
| Rate for Payer: United Healthcare Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare |
$574.20
|
| Rate for Payer: WINHealth Partners Commercial |
$970.20
|
| Rate for Payer: Wise Provider Network Commercial |
$940.50
|
|
|
HC INJECTION KNEE ARTHROGRAPHY RT
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
HCPCS 27370
|
| Hospital Charge Code |
3202737001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.73 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$970.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$950.40
|
| Rate for Payer: Altius Commercial |
$950.40
|
| Rate for Payer: Beech Street Commercial |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$812.79
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$960.30
|
| Rate for Payer: Cigna of WY Commercial |
$970.20
|
| Rate for Payer: Entrust Commercial |
$940.50
|
| Rate for Payer: First Choice Health Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.40
|
| Rate for Payer: HealthUtah PPO |
$990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$960.30
|
| Rate for Payer: Multiplan Medicare/VA |
$620.73
|
| Rate for Payer: One Health Plan of WY PPO |
$970.20
|
| Rate for Payer: PacificSource Commercial |
$891.00
|
| Rate for Payer: PHCS PPO |
$970.20
|
| Rate for Payer: Three Rivers PPO |
$742.50
|
| Rate for Payer: TriWest Veterans Administration |
$653.40
|
| Rate for Payer: United Healthcare Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare |
$653.40
|
| Rate for Payer: WINHealth Partners Commercial |
$940.50
|
| Rate for Payer: Wise Provider Network Commercial |
$940.50
|
|
|
HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
3206228401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$689.70 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$726.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$689.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$726.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
3206228401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,078.00
|
| Rate for Payer: Aetna of WY Medicare |
$726.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,056.00
|
| Rate for Payer: Altius Commercial |
$1,056.00
|
| Rate for Payer: Beech Street Commercial |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.10
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,067.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,078.00
|
| Rate for Payer: Entrust Commercial |
$1,045.00
|
| Rate for Payer: First Choice Health Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,045.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.00
|
| Rate for Payer: HealthUtah PPO |
$1,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,067.00
|
| Rate for Payer: Multiplan Medicare/VA |
$606.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,078.00
|
| Rate for Payer: PacificSource Commercial |
$990.00
|
| Rate for Payer: PHCS PPO |
$1,078.00
|
| Rate for Payer: Three Rivers PPO |
$825.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.00
|
| Rate for Payer: United Healthcare Commercial |
$957.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,078.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,045.00
|
|
|
HC INJECTION,SACROILIAC JOINT
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3612709601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECTION,SACROILIAC JOINT
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3612709601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC INJECTION,SACROILIAC JOINT BILAT
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3502709601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,195.67 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,126.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,432.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,083.20
|
| Rate for Payer: Altius Commercial |
$2,083.20
|
| Rate for Payer: Beech Street Commercial |
$2,126.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,781.57
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,104.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,126.60
|
| Rate for Payer: Entrust Commercial |
$2,061.50
|
| Rate for Payer: First Choice Health Commercial |
$2,061.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,061.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,258.60
|
| Rate for Payer: HealthUtah PPO |
$2,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,104.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,195.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,126.60
|
| Rate for Payer: PacificSource Commercial |
$1,953.00
|
| Rate for Payer: PHCS PPO |
$2,126.60
|
| Rate for Payer: Three Rivers PPO |
$1,627.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,258.60
|
| Rate for Payer: United Healthcare Commercial |
$1,887.90
|
| Rate for Payer: United Healthcare Medicare |
$1,258.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,126.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,061.50
|
|
|
HC INJECTION,SACROILIAC JOINT BILAT
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3502709601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.59 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,126.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,083.20
|
| Rate for Payer: Altius Commercial |
$2,083.20
|
| Rate for Payer: Beech Street Commercial |
$2,126.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,781.57
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,104.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,126.60
|
| Rate for Payer: Entrust Commercial |
$2,061.50
|
| Rate for Payer: First Choice Health Commercial |
$2,061.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,061.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,432.20
|
| Rate for Payer: HealthUtah PPO |
$2,170.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,104.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,360.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,126.60
|
| Rate for Payer: PacificSource Commercial |
$1,953.00
|
| Rate for Payer: PHCS PPO |
$2,126.60
|
| Rate for Payer: Three Rivers PPO |
$1,627.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,432.20
|
| Rate for Payer: United Healthcare Commercial |
$1,887.90
|
| Rate for Payer: United Healthcare Medicare |
$1,432.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,061.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,061.50
|
|
|
HC INJECTION,SACROILIAC JOINT LT
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3502709602
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$611.61 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Aetna of WY Medicare |
$732.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,065.60
|
| Rate for Payer: Altius Commercial |
$1,065.60
|
| Rate for Payer: Beech Street Commercial |
$1,087.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.31
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Entrust Commercial |
$1,054.50
|
| Rate for Payer: First Choice Health Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.80
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$611.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,087.80
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$643.80
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$643.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,087.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.50
|
|
|
HC INJECTION,SACROILIAC JOINT LT
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3202709602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$611.61 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Aetna of WY Medicare |
$732.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,065.60
|
| Rate for Payer: Altius Commercial |
$1,065.60
|
| Rate for Payer: Beech Street Commercial |
$1,087.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.31
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Entrust Commercial |
$1,054.50
|
| Rate for Payer: First Choice Health Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.80
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$611.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,087.80
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$643.80
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$643.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,087.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.50
|
|
|
HC INJECTION,SACROILIAC JOINT LT
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3502709602
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$695.97 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,065.60
|
| Rate for Payer: Altius Commercial |
$1,065.60
|
| Rate for Payer: Beech Street Commercial |
$1,087.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.31
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Entrust Commercial |
$1,054.50
|
| Rate for Payer: First Choice Health Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$732.60
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$695.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,087.80
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$732.60
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$732.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.50
|
|
|
HC INJECTION,SACROILIAC JOINT LT
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3202709602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$695.97 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,065.60
|
| Rate for Payer: Altius Commercial |
$1,065.60
|
| Rate for Payer: Beech Street Commercial |
$1,087.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.31
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Entrust Commercial |
$1,054.50
|
| Rate for Payer: First Choice Health Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$732.60
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$695.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,087.80
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$732.60
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$732.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.50
|
|
|
HC INJECTION,SACROILIAC JOINT RT
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3202709601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$611.61 |
| Max. Negotiated Rate |
$1,110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,087.80
|
| Rate for Payer: Aetna of WY Medicare |
$732.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,065.60
|
| Rate for Payer: Altius Commercial |
$1,065.60
|
| Rate for Payer: Beech Street Commercial |
$1,087.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$911.31
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,076.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,087.80
|
| Rate for Payer: Entrust Commercial |
$1,054.50
|
| Rate for Payer: First Choice Health Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,054.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.80
|
| Rate for Payer: HealthUtah PPO |
$1,110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,076.70
|
| Rate for Payer: Multiplan Medicare/VA |
$611.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,087.80
|
| Rate for Payer: PacificSource Commercial |
$999.00
|
| Rate for Payer: PHCS PPO |
$1,087.80
|
| Rate for Payer: Three Rivers PPO |
$832.50
|
| Rate for Payer: TriWest Veterans Administration |
$643.80
|
| Rate for Payer: United Healthcare Commercial |
$965.70
|
| Rate for Payer: United Healthcare Medicare |
$643.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,087.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,054.50
|
|
