|
HC APPL GNTLT-HND/LWR FOREARM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
7612908501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APPLICATION CAST ELBOW FINGER SHORT ARM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7612907501
|
|
Hospital Revenue Code
|
761
|
| 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 APPLICATION CAST ELBOW FINGER SHORT ARM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7612907501
|
|
Hospital Revenue Code
|
761
|
| 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 APPLICATION CAST FINGER
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
5102908601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Aetna of WY Medicare |
$47.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$69.12
|
| Rate for Payer: Altius Commercial |
$69.12
|
| Rate for Payer: Beech Street Commercial |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.11
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: Entrust Commercial |
$68.40
|
| Rate for Payer: First Choice Health Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.76
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$39.67
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$70.56
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$41.76
|
| Rate for Payer: United Healthcare Commercial |
$62.64
|
| Rate for Payer: United Healthcare Medicare |
$41.76
|
| Rate for Payer: WINHealth Partners Commercial |
$70.56
|
| Rate for Payer: Wise Provider Network Commercial |
$68.40
|
|
|
HC APPLICATION CAST FINGER
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
5102908601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$69.12
|
| Rate for Payer: Altius Commercial |
$69.12
|
| Rate for Payer: Beech Street Commercial |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.11
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: Entrust Commercial |
$68.40
|
| Rate for Payer: First Choice Health Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.52
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$45.14
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$70.56
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.52
|
| Rate for Payer: United Healthcare Commercial |
$62.64
|
| Rate for Payer: United Healthcare Medicare |
$47.52
|
| Rate for Payer: WINHealth Partners Commercial |
$68.40
|
| Rate for Payer: Wise Provider Network Commercial |
$68.40
|
|
|
HC APPLICATION LONG LEG CAST THIGH-TOE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$62.70
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$66.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC APPLICATION LONG LEG CAST THIGH-TOE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$96.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$82.10
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$55.10
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$58.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.72
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.85
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.62
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$67.09
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.62
|
| Rate for Payer: United Healthcare Commercial |
$93.09
|
| Rate for Payer: United Healthcare Medicare |
$70.62
|
| Rate for Payer: WINHealth Partners Commercial |
$101.65
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.86
|
| Rate for Payer: Aetna of WY Medicare |
$70.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.72
|
| Rate for Payer: Altius Commercial |
$102.72
|
| Rate for Payer: Beech Street Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.85
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.79
|
| Rate for Payer: Cigna of WY Commercial |
$104.86
|
| Rate for Payer: Entrust Commercial |
$101.65
|
| Rate for Payer: First Choice Health Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.06
|
| Rate for Payer: HealthUtah PPO |
$107.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.79
|
| Rate for Payer: Multiplan Medicare/VA |
$58.96
|
| Rate for Payer: One Health Plan of WY PPO |
$104.86
|
| Rate for Payer: PacificSource Commercial |
$96.30
|
| Rate for Payer: PHCS PPO |
$104.86
|
| Rate for Payer: Three Rivers PPO |
$80.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.06
|
| Rate for Payer: United Healthcare Commercial |
$93.09
|
| Rate for Payer: United Healthcare Medicare |
$62.06
|
| Rate for Payer: WINHealth Partners Commercial |
$104.86
|
| Rate for Payer: Wise Provider Network Commercial |
$101.65
|
|
|
HC APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
5102950501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$33.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$27.55
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49.00
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
5102950501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.00
|
| Rate for Payer: Altius Commercial |
$48.00
|
| Rate for Payer: Beech Street Commercial |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: Entrust Commercial |
$47.50
|
| Rate for Payer: First Choice Health Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$49.00
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
| Rate for Payer: Wise Provider Network Commercial |
$47.50
|
|
|
HC APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
5102069201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$632.00 |
| Max. Negotiated Rate |
$1,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,124.06
|
| Rate for Payer: Aetna of WY Medicare |
$757.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,101.12
|
| Rate for Payer: Altius Commercial |
$1,101.12
|
| Rate for Payer: Beech Street Commercial |
$1,124.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$941.69
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,112.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,124.06
|
| Rate for Payer: Entrust Commercial |
$1,089.65
|
| Rate for Payer: First Choice Health Commercial |
$1,089.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,089.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$665.26
|
| Rate for Payer: HealthUtah PPO |
$1,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,112.59
|
| Rate for Payer: Multiplan Medicare/VA |
$632.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,124.06
|
| Rate for Payer: PacificSource Commercial |
$1,032.30
|
| Rate for Payer: PHCS PPO |
$1,124.06
|
| Rate for Payer: Three Rivers PPO |
$860.25
|
| Rate for Payer: TriWest Veterans Administration |
$665.26
|
| Rate for Payer: United Healthcare Commercial |
$997.89
|
| Rate for Payer: United Healthcare Medicare |
$665.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,124.06
|
| Rate for Payer: Wise Provider Network Commercial |
$1,089.65
|
|
|
HC APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
5102069201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$719.17 |
| Max. Negotiated Rate |
$1,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,124.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,101.12
|
| Rate for Payer: Altius Commercial |
$1,101.12
|
| Rate for Payer: Beech Street Commercial |
$1,124.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$941.69
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,112.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,124.06
|
| Rate for Payer: Entrust Commercial |
$1,089.65
|
| Rate for Payer: First Choice Health Commercial |
$1,089.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,089.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$757.02
|
| Rate for Payer: HealthUtah PPO |
$1,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,112.59
|
| Rate for Payer: Multiplan Medicare/VA |
$719.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,124.06
|
| Rate for Payer: PacificSource Commercial |
$1,032.30
|
| Rate for Payer: PHCS PPO |
$1,124.06
|
| Rate for Payer: Three Rivers PPO |
$860.25
|
| Rate for Payer: TriWest Veterans Administration |
$757.02
|
| Rate for Payer: United Healthcare Commercial |
$997.89
|
| Rate for Payer: United Healthcare Medicare |
$757.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,089.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,089.65
|
|
|
HC APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.51 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Aetna of WY Medicare |
$38.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.22
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$32.51
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.22
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$34.22
|
| Rate for Payer: WINHealth Partners Commercial |
$57.82
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.64
|
| Rate for Payer: Altius Commercial |
$56.64
|
| Rate for Payer: Beech Street Commercial |
$57.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.44
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.23
|
| Rate for Payer: Cigna of WY Commercial |
$57.82
|
| Rate for Payer: Entrust Commercial |
$56.05
|
| Rate for Payer: First Choice Health Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.94
|
| Rate for Payer: HealthUtah PPO |
$59.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.23
|
| Rate for Payer: Multiplan Medicare/VA |
$36.99
|
| Rate for Payer: One Health Plan of WY PPO |
$57.82
|
| Rate for Payer: PacificSource Commercial |
$53.10
|
| Rate for Payer: PHCS PPO |
$57.82
|
| Rate for Payer: Three Rivers PPO |
$44.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.94
|
| Rate for Payer: United Healthcare Commercial |
$51.33
|
| Rate for Payer: United Healthcare Medicare |
$38.94
|
| Rate for Payer: WINHealth Partners Commercial |
$56.05
|
| Rate for Payer: Wise Provider Network Commercial |
$56.05
|
|
|
HC APPLICATION SHRT LEG CAST WALK/AMBUL
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
5102942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.30
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$34.48
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.30
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$36.30
|
| Rate for Payer: WINHealth Partners Commercial |
$52.25
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC APPLICATION SHRT LEG CAST WALK/AMBUL
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
5102942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
5102069001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$383.10 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$598.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$586.56
|
| Rate for Payer: Altius Commercial |
$586.56
|
| Rate for Payer: Beech Street Commercial |
$598.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$501.63
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$592.67
|
| Rate for Payer: Cigna of WY Commercial |
$598.78
|
| Rate for Payer: Entrust Commercial |
$580.45
|
| Rate for Payer: First Choice Health Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.26
|
| Rate for Payer: HealthUtah PPO |
$611.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$592.67
|
| Rate for Payer: Multiplan Medicare/VA |
$383.10
|
| Rate for Payer: One Health Plan of WY PPO |
$598.78
|
| Rate for Payer: PacificSource Commercial |
$549.90
|
| Rate for Payer: PHCS PPO |
$598.78
|
| Rate for Payer: Three Rivers PPO |
$458.25
|
| Rate for Payer: TriWest Veterans Administration |
$403.26
|
| Rate for Payer: United Healthcare Commercial |
$531.57
|
| Rate for Payer: United Healthcare Medicare |
$403.26
|
| Rate for Payer: WINHealth Partners Commercial |
$580.45
|
| Rate for Payer: Wise Provider Network Commercial |
$580.45
|
|
|
HC APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
5102069001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$336.66 |
| Max. Negotiated Rate |
$611.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$598.78
|
| Rate for Payer: Aetna of WY Medicare |
$403.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$586.56
|
| Rate for Payer: Altius Commercial |
$586.56
|
| Rate for Payer: Beech Street Commercial |
$598.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$501.63
|
| Rate for Payer: Cash Price |
$427.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$592.67
|
| Rate for Payer: Cigna of WY Commercial |
$598.78
|
| Rate for Payer: Entrust Commercial |
$580.45
|
| Rate for Payer: First Choice Health Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$580.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$354.38
|
| Rate for Payer: HealthUtah PPO |
$611.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$592.67
|
| Rate for Payer: Multiplan Medicare/VA |
$336.66
|
| Rate for Payer: One Health Plan of WY PPO |
$598.78
|
| Rate for Payer: PacificSource Commercial |
$549.90
|
| Rate for Payer: PHCS PPO |
$598.78
|
| Rate for Payer: Three Rivers PPO |
$458.25
|
| Rate for Payer: TriWest Veterans Administration |
$354.38
|
| Rate for Payer: United Healthcare Commercial |
$531.57
|
| Rate for Payer: United Healthcare Medicare |
$354.38
|
| Rate for Payer: WINHealth Partners Commercial |
$598.78
|
| Rate for Payer: Wise Provider Network Commercial |
$580.45
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$359.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.10
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$300.30
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$316.10
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$316.10
|
| Rate for Payer: WINHealth Partners Commercial |
$534.10
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$341.72 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.70
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$341.72
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$359.70
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
| Rate for Payer: WINHealth Partners Commercial |
$517.75
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$73.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.38
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$61.16
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$64.38
|
| Rate for Payer: United Healthcare Commercial |
$96.57
|
| Rate for Payer: United Healthcare Medicare |
$64.38
|
| Rate for Payer: WINHealth Partners Commercial |
$108.78
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$106.56
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.13
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.26
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$69.60
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$73.26
|
| Rate for Payer: United Healthcare Commercial |
$96.57
|
| Rate for Payer: United Healthcare Medicare |
$73.26
|
| Rate for Payer: WINHealth Partners Commercial |
$105.45
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
5102913001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Aetna of WY Medicare |
$19.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.84
|
| Rate for Payer: Altius Commercial |
$27.84
|
| Rate for Payer: Beech Street Commercial |
$28.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.81
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: Entrust Commercial |
$27.55
|
| Rate for Payer: First Choice Health Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.82
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$15.98
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$28.42
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.82
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$16.82
|
| Rate for Payer: WINHealth Partners Commercial |
$28.42
|
| Rate for Payer: Wise Provider Network Commercial |
$27.55
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
