|
HC INJECT TENDON ORIGIN/INSERT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
7612055101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TENDON ORIGIN/INSERT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
5102055101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.78
|
| Rate for Payer: Aetna of WY Medicare |
$7.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.56
|
| Rate for Payer: Altius Commercial |
$10.56
|
| Rate for Payer: Beech Street Commercial |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.67
|
| Rate for Payer: Cigna of WY Commercial |
$10.78
|
| Rate for Payer: Entrust Commercial |
$10.45
|
| Rate for Payer: First Choice Health Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.38
|
| Rate for Payer: HealthUtah PPO |
$11.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.67
|
| Rate for Payer: Multiplan Medicare/VA |
$6.06
|
| Rate for Payer: One Health Plan of WY PPO |
$10.78
|
| Rate for Payer: PacificSource Commercial |
$9.90
|
| Rate for Payer: PHCS PPO |
$10.78
|
| Rate for Payer: Three Rivers PPO |
$8.25
|
| Rate for Payer: TriWest Veterans Administration |
$6.38
|
| Rate for Payer: United Healthcare Commercial |
$9.57
|
| Rate for Payer: United Healthcare Medicare |
$6.38
|
| Rate for Payer: WINHealth Partners Commercial |
$10.78
|
| Rate for Payer: Wise Provider Network Commercial |
$10.45
|
|
|
HC INJECT TENDON ORIGIN/INSERT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
5102055101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.56
|
| Rate for Payer: Altius Commercial |
$10.56
|
| Rate for Payer: Beech Street Commercial |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.67
|
| Rate for Payer: Cigna of WY Commercial |
$10.78
|
| Rate for Payer: Entrust Commercial |
$10.45
|
| Rate for Payer: First Choice Health Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.26
|
| Rate for Payer: HealthUtah PPO |
$11.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.67
|
| Rate for Payer: Multiplan Medicare/VA |
$6.90
|
| Rate for Payer: One Health Plan of WY PPO |
$10.78
|
| Rate for Payer: PacificSource Commercial |
$9.90
|
| Rate for Payer: PHCS PPO |
$10.78
|
| Rate for Payer: Three Rivers PPO |
$8.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.26
|
| Rate for Payer: United Healthcare Commercial |
$9.57
|
| Rate for Payer: United Healthcare Medicare |
$7.26
|
| Rate for Payer: WINHealth Partners Commercial |
$10.45
|
| Rate for Payer: Wise Provider Network Commercial |
$10.45
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
7612055001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
7612055001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 20550 50
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$114.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.04
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.85
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.92
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$95.87
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.92
|
| Rate for Payer: United Healthcare Commercial |
$151.38
|
| Rate for Payer: United Healthcare Medicare |
$100.92
|
| Rate for Payer: WINHealth Partners Commercial |
$170.52
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 20550 50
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.10 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.04
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$142.85
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.84
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$109.10
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$114.84
|
| Rate for Payer: United Healthcare Commercial |
$151.38
|
| Rate for Payer: United Healthcare Medicare |
$114.84
|
| Rate for Payer: WINHealth Partners Commercial |
$165.30
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$57.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.46
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$47.94
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$50.46
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
| Rate for Payer: WINHealth Partners Commercial |
$85.26
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC INJECT TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.52
|
| Rate for Payer: Altius Commercial |
$83.52
|
| Rate for Payer: Beech Street Commercial |
$85.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.43
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: Entrust Commercial |
$82.65
|
| Rate for Payer: First Choice Health Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.42
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$54.55
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$85.26
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$57.42
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
| Rate for Payer: Wise Provider Network Commercial |
$82.65
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
7612055201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
7612055201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
5102055201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.04
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$20.94
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.04
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$22.04
|
| Rate for Payer: WINHealth Partners Commercial |
$37.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
5102055201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.48
|
| Rate for Payer: Altius Commercial |
$36.48
|
| Rate for Payer: Beech Street Commercial |
$37.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.86
|
| Rate for Payer: Cigna of WY Commercial |
$37.24
|
| Rate for Payer: Entrust Commercial |
$36.10
|
| Rate for Payer: First Choice Health Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.08
|
| Rate for Payer: HealthUtah PPO |
$38.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.86
|
| Rate for Payer: Multiplan Medicare/VA |
$23.83
|
| Rate for Payer: One Health Plan of WY PPO |
$37.24
|
| Rate for Payer: PacificSource Commercial |
$34.20
|
| Rate for Payer: PHCS PPO |
$37.24
|
| Rate for Payer: Three Rivers PPO |
$28.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.08
|
| Rate for Payer: United Healthcare Commercial |
$33.06
|
| Rate for Payer: United Healthcare Medicare |
$25.08
|
| Rate for Payer: WINHealth Partners Commercial |
$36.10
|
| Rate for Payer: Wise Provider Network Commercial |
$36.10
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
5102055301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$28.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.94
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.69
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$24.94
|
| Rate for Payer: WINHealth Partners Commercial |
$42.14
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
7612055301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
7612055301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
5102055301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.28
|
| Rate for Payer: Altius Commercial |
$41.28
|
| Rate for Payer: Beech Street Commercial |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.30
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: Entrust Commercial |
$40.85
|
| Rate for Payer: First Choice Health Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.38
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$26.96
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$42.14
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.38
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$28.38
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
| Rate for Payer: Wise Provider Network Commercial |
$40.85
|
|
|
HC INJ,LUMB EPIDUR,BLOOD/CLOT PATCH
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
7616227301
|
|
Hospital Revenue Code
|
761
|
| 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 INJ,LUMB EPIDUR,BLOOD/CLOT PATCH
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
7616227301
|
|
Hospital Revenue Code
|
761
|
| 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 INJ PERFLUTREN LIP MICROS, PER ML
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
636Q995701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.30
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$191.24
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$201.30
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$201.30
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC INJ PERFLUTREN LIP MICROS, PER ML
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
636Q995701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$201.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$292.80
|
| Rate for Payer: Altius Commercial |
$292.80
|
| Rate for Payer: Beech Street Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$250.40
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: Entrust Commercial |
$289.75
|
| Rate for Payer: First Choice Health Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.90
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$168.06
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$298.90
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$176.90
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$176.90
|
| Rate for Payer: WINHealth Partners Commercial |
$298.90
|
| Rate for Payer: Wise Provider Network Commercial |
$289.75
|
|
|
HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
3202335001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$743.85 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,323.00
|
| Rate for Payer: Aetna of WY Medicare |
$891.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,296.00
|
| Rate for Payer: Altius Commercial |
$1,296.00
|
| Rate for Payer: Beech Street Commercial |
$1,323.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,108.35
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,309.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,323.00
|
| Rate for Payer: Entrust Commercial |
$1,282.50
|
| Rate for Payer: First Choice Health Commercial |
$1,282.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,282.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$783.00
|
| Rate for Payer: HealthUtah PPO |
$1,350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,309.50
|
| Rate for Payer: Multiplan Medicare/VA |
$743.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,323.00
|
| Rate for Payer: PacificSource Commercial |
$1,215.00
|
| Rate for Payer: PHCS PPO |
$1,323.00
|
| Rate for Payer: Three Rivers PPO |
$1,012.50
|
| Rate for Payer: TriWest Veterans Administration |
$783.00
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
| Rate for Payer: United Healthcare Medicare |
$783.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,282.50
|
|
|
HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
3202335001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$846.45 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,323.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,296.00
|
| Rate for Payer: Altius Commercial |
$1,296.00
|
| Rate for Payer: Beech Street Commercial |
$1,323.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,108.35
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,309.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,323.00
|
| Rate for Payer: Entrust Commercial |
$1,282.50
|
| Rate for Payer: First Choice Health Commercial |
$1,282.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,282.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$891.00
|
| Rate for Payer: HealthUtah PPO |
$1,350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,309.50
|
| Rate for Payer: Multiplan Medicare/VA |
$846.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,323.00
|
| Rate for Payer: PacificSource Commercial |
$1,215.00
|
| Rate for Payer: PHCS PPO |
$1,323.00
|
| Rate for Payer: Three Rivers PPO |
$1,012.50
|
| Rate for Payer: TriWest Veterans Administration |
$891.00
|
| Rate for Payer: United Healthcare Commercial |
$1,174.50
|
| Rate for Payer: United Healthcare Medicare |
$891.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,282.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,282.50
|
|
|
HC INSERT CATH,ART,PERCUT,SHORTTERM
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
7613662001
|
|
Hospital Revenue Code
|
761
|
| 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 INSERT CATH,ART,PERCUT,SHORTTERM
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
7613662001
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
