|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
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 FOREARM CAST
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
700
|
| 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 APPLY FOREARM CAST
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.92
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$38.87
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.92
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$40.92
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$40.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$59.52
|
| Rate for Payer: Altius Commercial |
$59.52
|
| Rate for Payer: Beech Street Commercial |
$60.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: Entrust Commercial |
$58.90
|
| Rate for Payer: First Choice Health Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.96
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$34.16
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$60.76
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.96
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$35.96
|
| Rate for Payer: WINHealth Partners Commercial |
$60.76
|
| Rate for Payer: Wise Provider Network Commercial |
$58.90
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 29075 50
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Aetna of WY Medicare |
$81.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.92
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$68.32
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$71.92
|
| Rate for Payer: United Healthcare Commercial |
$107.88
|
| Rate for Payer: United Healthcare Medicare |
$71.92
|
| Rate for Payer: WINHealth Partners Commercial |
$121.52
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 29075 50
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.75 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.04
|
| Rate for Payer: Altius Commercial |
$119.04
|
| Rate for Payer: Beech Street Commercial |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$86.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.28
|
| Rate for Payer: Cigna of WY Commercial |
$121.52
|
| Rate for Payer: Entrust Commercial |
$117.80
|
| Rate for Payer: First Choice Health Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.84
|
| Rate for Payer: HealthUtah PPO |
$124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.28
|
| Rate for Payer: Multiplan Medicare/VA |
$77.75
|
| Rate for Payer: One Health Plan of WY PPO |
$121.52
|
| Rate for Payer: PacificSource Commercial |
$111.60
|
| Rate for Payer: PHCS PPO |
$121.52
|
| Rate for Payer: Three Rivers PPO |
$93.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.84
|
| Rate for Payer: United Healthcare Commercial |
$107.88
|
| Rate for Payer: United Healthcare Medicare |
$81.84
|
| Rate for Payer: WINHealth Partners Commercial |
$117.80
|
| Rate for Payer: Wise Provider Network Commercial |
$117.80
|
|
|
HC APPLY FOREARM SPLINT,DYNAMIC
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
7002912601
|
|
Hospital Revenue Code
|
700
|
| 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 APPLY FOREARM SPLINT,DYNAMIC
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
7002912601
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$21.32
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.44
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$22.44
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$32.30
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$22.44
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.64
|
| Rate for Payer: Altius Commercial |
$32.64
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Beech Street Commercial |
$33.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: Entrust Commercial |
$32.30
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: Multiplan Medicare/VA |
$18.73
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: PHCS PPO |
$33.32
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.72
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$19.72
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: WINHealth Partners Commercial |
$33.32
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$32.30
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.84
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$26.45
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.84
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$27.84
|
| Rate for Payer: WINHealth Partners Commercial |
$47.04
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.08
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.68
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.10
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.68
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$31.68
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$66.24
|
| Rate for Payer: Altius Commercial |
$66.24
|
| Rate for Payer: Beech Street Commercial |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.65
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.93
|
| Rate for Payer: Cigna of WY Commercial |
$67.62
|
| Rate for Payer: Entrust Commercial |
$65.55
|
| Rate for Payer: First Choice Health Commercial |
$65.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.54
|
| Rate for Payer: HealthUtah PPO |
$69.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.93
|
| Rate for Payer: Multiplan Medicare/VA |
$43.26
|
| Rate for Payer: One Health Plan of WY PPO |
$67.62
|
| Rate for Payer: PacificSource Commercial |
$62.10
|
| Rate for Payer: PHCS PPO |
$67.62
|
| Rate for Payer: Three Rivers PPO |
$51.75
|
| Rate for Payer: TriWest Veterans Administration |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$60.03
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
| Rate for Payer: WINHealth Partners Commercial |
$65.55
|
| Rate for Payer: Wise Provider Network Commercial |
$65.55
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
7612906501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
7612906501
|
|
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 APPLY LONG ARM CAST
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.62
|
| Rate for Payer: Aetna of WY Medicare |
$45.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$66.24
|
| Rate for Payer: Altius Commercial |
$66.24
|
| Rate for Payer: Beech Street Commercial |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.65
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.93
|
| Rate for Payer: Cigna of WY Commercial |
$67.62
|
| Rate for Payer: Entrust Commercial |
$65.55
|
| Rate for Payer: First Choice Health Commercial |
$65.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.02
|
| Rate for Payer: HealthUtah PPO |
$69.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.93
|
| Rate for Payer: Multiplan Medicare/VA |
$38.02
|
| Rate for Payer: One Health Plan of WY PPO |
$67.62
|
| Rate for Payer: PacificSource Commercial |
$62.10
|
| Rate for Payer: PHCS PPO |
$67.62
|
| Rate for Payer: Three Rivers PPO |
$51.75
|
| Rate for Payer: TriWest Veterans Administration |
$40.02
|
| Rate for Payer: United Healthcare Commercial |
$60.03
|
| Rate for Payer: United Healthcare Medicare |
$40.02
|
| Rate for Payer: WINHealth Partners Commercial |
$67.62
|
| Rate for Payer: Wise Provider Network Commercial |
$65.55
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 29105 50
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Medicare |
$77.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$112.32
|
| Rate for Payer: Altius Commercial |
$112.32
|
| Rate for Payer: Beech Street Commercial |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.06
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: Entrust Commercial |
$111.15
|
| Rate for Payer: First Choice Health Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.86
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$64.47
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$114.66
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.86
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$67.86
|
| Rate for Payer: WINHealth Partners Commercial |
$114.66
|
| Rate for Payer: Wise Provider Network Commercial |
$111.15
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
7612910501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 29105 50
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$112.32
|
| Rate for Payer: Altius Commercial |
$112.32
|
| Rate for Payer: Beech Street Commercial |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.06
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: Entrust Commercial |
$111.15
|
| Rate for Payer: First Choice Health Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.22
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$73.36
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PHCS PPO |
$114.66
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.22
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$77.22
|
| Rate for Payer: WINHealth Partners Commercial |
$111.15
|
| Rate for Payer: Wise Provider Network Commercial |
$111.15
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.68
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.62
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.28
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$36.37
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.28
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Medicare |
$38.28
|
| Rate for Payer: WINHealth Partners Commercial |
$55.10
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.84
|
| Rate for Payer: Aetna of WY Medicare |
$38.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.68
|
| Rate for Payer: Altius Commercial |
$55.68
|
| Rate for Payer: Beech Street Commercial |
$56.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.62
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.26
|
| Rate for Payer: Cigna of WY Commercial |
$56.84
|
| Rate for Payer: Entrust Commercial |
$55.10
|
| Rate for Payer: First Choice Health Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.64
|
| Rate for Payer: HealthUtah PPO |
$58.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.26
|
| Rate for Payer: Multiplan Medicare/VA |
$31.96
|
| Rate for Payer: One Health Plan of WY PPO |
$56.84
|
| Rate for Payer: PacificSource Commercial |
$52.20
|
| Rate for Payer: PHCS PPO |
$56.84
|
| Rate for Payer: Three Rivers PPO |
$43.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$50.46
|
| Rate for Payer: United Healthcare Medicare |
$33.64
|
| Rate for Payer: WINHealth Partners Commercial |
$56.84
|
| Rate for Payer: Wise Provider Network Commercial |
$55.10
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
7612910501
|
|
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 APPLY LONG LEG SPLINT
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
7002950501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| 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 |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| 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 |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
