|
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
|
|
|
HC INJECTION,SACROILIAC JOINT RT
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
3202709601
|
|
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 |
3502709603
|
|
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 SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
5103647101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$52.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$75.84
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.82
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$43.53
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$45.82
|
| Rate for Payer: United Healthcare Commercial |
$68.73
|
| Rate for Payer: United Healthcare Medicare |
$45.82
|
| Rate for Payer: WINHealth Partners Commercial |
$77.42
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
5103647101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.53 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$75.84
|
| Rate for Payer: Altius Commercial |
$75.84
|
| Rate for Payer: Beech Street Commercial |
$77.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: Entrust Commercial |
$75.05
|
| Rate for Payer: First Choice Health Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.14
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$49.53
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$77.42
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$52.14
|
| Rate for Payer: United Healthcare Commercial |
$68.73
|
| Rate for Payer: United Healthcare Medicare |
$52.14
|
| Rate for Payer: WINHealth Partners Commercial |
$75.05
|
| Rate for Payer: Wise Provider Network Commercial |
$75.05
|
|
|
HC INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
5103647001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$25.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.62
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$21.49
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$22.62
|
| Rate for Payer: WINHealth Partners Commercial |
$38.22
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC INJECTION SCLEROSANT SINGLE INCMPTNT VEIN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
5103647001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.44
|
| Rate for Payer: Altius Commercial |
$37.44
|
| Rate for Payer: Beech Street Commercial |
$38.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: Entrust Commercial |
$37.05
|
| Rate for Payer: First Choice Health Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.74
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$24.45
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$38.22
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$25.74
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$25.74
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
| Rate for Payer: Wise Provider Network Commercial |
$37.05
|
|
|
HC INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 20500
|
| Hospital Charge Code |
5102050001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.44
|
| Rate for Payer: Altius Commercial |
$85.44
|
| Rate for Payer: Beech Street Commercial |
$87.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: Entrust Commercial |
$84.55
|
| Rate for Payer: First Choice Health Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$55.80
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$87.22
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$84.55
|
| Rate for Payer: Wise Provider Network Commercial |
$84.55
|
|
|
HC INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 20500
|
| Hospital Charge Code |
5102050001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.44
|
| Rate for Payer: Altius Commercial |
$85.44
|
| Rate for Payer: Beech Street Commercial |
$87.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: Entrust Commercial |
$84.55
|
| Rate for Payer: First Choice Health Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.62
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$49.04
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$87.22
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$51.62
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$51.62
|
| Rate for Payer: WINHealth Partners Commercial |
$87.22
|
| Rate for Payer: Wise Provider Network Commercial |
$84.55
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
5103646801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.08
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$55.18
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.08
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Medicare |
$58.08
|
| Rate for Payer: WINHealth Partners Commercial |
$83.60
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 36468
|
| Hospital Charge Code |
5103646801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Aetna of WY Medicare |
$58.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.48
|
| Rate for Payer: Altius Commercial |
$84.48
|
| Rate for Payer: Beech Street Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.25
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: Entrust Commercial |
$83.60
|
| Rate for Payer: First Choice Health Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.04
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$48.49
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PHCS PPO |
$86.24
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.04
|
| Rate for Payer: United Healthcare Commercial |
$76.56
|
| Rate for Payer: United Healthcare Medicare |
$51.04
|
| Rate for Payer: WINHealth Partners Commercial |
$86.24
|
| Rate for Payer: Wise Provider Network Commercial |
$83.60
|
|
|
HC INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 20526 50
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Aetna of WY Medicare |
$37.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.72
|
| Rate for Payer: Altius Commercial |
$54.72
|
| Rate for Payer: Beech Street Commercial |
$55.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: Entrust Commercial |
$54.15
|
| Rate for Payer: First Choice Health Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.06
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$31.41
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$55.86
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.06
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$33.06
|
| Rate for Payer: WINHealth Partners Commercial |
$55.86
|
| Rate for Payer: Wise Provider Network Commercial |
$54.15
|
|
|
HC INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 20526 50
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC INJECTION THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.72
|
| Rate for Payer: Altius Commercial |
$54.72
|
| Rate for Payer: Beech Street Commercial |
$55.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.80
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: Entrust Commercial |
$54.15
|
| Rate for Payer: First Choice Health Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.62
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$35.74
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$55.86
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$37.62
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$37.62
|
| Rate for Payer: WINHealth Partners Commercial |
$54.15
|
| Rate for Payer: Wise Provider Network Commercial |
$54.15
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.10
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$116.00
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.10
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$122.10
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
7619637201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Aetna of WY Medicare |
$122.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$177.60
|
| Rate for Payer: Altius Commercial |
$177.60
|
| Rate for Payer: Beech Street Commercial |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$151.88
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: Entrust Commercial |
$175.75
|
| Rate for Payer: First Choice Health Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.30
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: Multiplan Medicare/VA |
$101.94
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$181.30
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.30
|
| Rate for Payer: United Healthcare Commercial |
$160.95
|
| Rate for Payer: United Healthcare Medicare |
$107.30
|
| Rate for Payer: WINHealth Partners Commercial |
$181.30
|
| Rate for Payer: Wise Provider Network Commercial |
$175.75
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
5109637201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
7619637201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
5109637201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.78
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.69
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.78
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$21.78
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
7619637501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
7619637501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
