|
HC CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
5102784001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$243.28 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$380.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$372.48
|
| Rate for Payer: Altius Commercial |
$372.48
|
| Rate for Payer: Beech Street Commercial |
$380.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$318.55
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.36
|
| Rate for Payer: Cigna of WY Commercial |
$380.24
|
| Rate for Payer: Entrust Commercial |
$368.60
|
| Rate for Payer: First Choice Health Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.08
|
| Rate for Payer: HealthUtah PPO |
$388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.36
|
| Rate for Payer: Multiplan Medicare/VA |
$243.28
|
| Rate for Payer: One Health Plan of WY PPO |
$380.24
|
| Rate for Payer: PacificSource Commercial |
$349.20
|
| Rate for Payer: PHCS PPO |
$380.24
|
| Rate for Payer: Three Rivers PPO |
$291.00
|
| Rate for Payer: TriWest Veterans Administration |
$256.08
|
| Rate for Payer: United Healthcare Commercial |
$337.56
|
| Rate for Payer: United Healthcare Medicare |
$256.08
|
| Rate for Payer: WINHealth Partners Commercial |
$368.60
|
| Rate for Payer: Wise Provider Network Commercial |
$368.60
|
|
|
HC CLOSED TX ANKLE DISLOCATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
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 CLOSED TX ANKLE DISLOCATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
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 CLOSED TX BIG TOE FX,MANIP
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
7612849501
|
|
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 CLOSED TX BIG TOE FX,MANIP
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
7612849501
|
|
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 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
7612781001
|
|
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 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
7612781001
|
|
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 CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
5102563001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.46 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$285.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$279.36
|
| Rate for Payer: Altius Commercial |
$279.36
|
| Rate for Payer: Beech Street Commercial |
$285.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.91
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$282.27
|
| Rate for Payer: Cigna of WY Commercial |
$285.18
|
| Rate for Payer: Entrust Commercial |
$276.45
|
| Rate for Payer: First Choice Health Commercial |
$276.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$276.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.06
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$282.27
|
| Rate for Payer: Multiplan Medicare/VA |
$182.46
|
| Rate for Payer: One Health Plan of WY PPO |
$285.18
|
| Rate for Payer: PacificSource Commercial |
$261.90
|
| Rate for Payer: PHCS PPO |
$285.18
|
| Rate for Payer: Three Rivers PPO |
$218.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.06
|
| Rate for Payer: United Healthcare Commercial |
$253.17
|
| Rate for Payer: United Healthcare Medicare |
$192.06
|
| Rate for Payer: WINHealth Partners Commercial |
$276.45
|
| Rate for Payer: Wise Provider Network Commercial |
$276.45
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
5102563001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.34 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$285.18
|
| Rate for Payer: Aetna of WY Medicare |
$192.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$279.36
|
| Rate for Payer: Altius Commercial |
$279.36
|
| Rate for Payer: Beech Street Commercial |
$285.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.91
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$282.27
|
| Rate for Payer: Cigna of WY Commercial |
$285.18
|
| Rate for Payer: Entrust Commercial |
$276.45
|
| Rate for Payer: First Choice Health Commercial |
$276.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$276.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.78
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$282.27
|
| Rate for Payer: Multiplan Medicare/VA |
$160.34
|
| Rate for Payer: One Health Plan of WY PPO |
$285.18
|
| Rate for Payer: PacificSource Commercial |
$261.90
|
| Rate for Payer: PHCS PPO |
$285.18
|
| Rate for Payer: Three Rivers PPO |
$218.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.78
|
| Rate for Payer: United Healthcare Commercial |
$253.17
|
| Rate for Payer: United Healthcare Medicare |
$168.78
|
| Rate for Payer: WINHealth Partners Commercial |
$285.18
|
| Rate for Payer: Wise Provider Network Commercial |
$276.45
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
7612563001
|
|
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 CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
7612563001
|
|
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 CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$283.22
|
| Rate for Payer: Aetna of WY Medicare |
$190.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$277.44
|
| Rate for Payer: Altius Commercial |
$277.44
|
| Rate for Payer: Beech Street Commercial |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$237.27
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$280.33
|
| Rate for Payer: Cigna of WY Commercial |
$283.22
|
| Rate for Payer: Entrust Commercial |
$274.55
|
| Rate for Payer: First Choice Health Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.62
|
| Rate for Payer: HealthUtah PPO |
$289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$280.33
|
| Rate for Payer: Multiplan Medicare/VA |
$159.24
|
| Rate for Payer: One Health Plan of WY PPO |
$283.22
|
| Rate for Payer: PacificSource Commercial |
$260.10
|
| Rate for Payer: PHCS PPO |
$283.22
|
| Rate for Payer: Three Rivers PPO |
$216.75
|
| Rate for Payer: TriWest Veterans Administration |
$167.62
|
| Rate for Payer: United Healthcare Commercial |
$251.43
|
| Rate for Payer: United Healthcare Medicare |
$167.62
|
| Rate for Payer: WINHealth Partners Commercial |
$283.22
|
| Rate for Payer: Wise Provider Network Commercial |
$274.55
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$283.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$277.44
|
| Rate for Payer: Altius Commercial |
$277.44
|
| Rate for Payer: Beech Street Commercial |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$237.27
|
| Rate for Payer: Cash Price |
$202.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$280.33
|
| Rate for Payer: Cigna of WY Commercial |
$283.22
|
| Rate for Payer: Entrust Commercial |
$274.55
|
| Rate for Payer: First Choice Health Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$274.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.74
|
| Rate for Payer: HealthUtah PPO |
$289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$280.33
|
| Rate for Payer: Multiplan Medicare/VA |
$181.20
|
| Rate for Payer: One Health Plan of WY PPO |
$283.22
|
| Rate for Payer: PacificSource Commercial |
$260.10
|
| Rate for Payer: PHCS PPO |
$283.22
|
| Rate for Payer: Three Rivers PPO |
$216.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.74
|
| Rate for Payer: United Healthcare Commercial |
$251.43
|
| Rate for Payer: United Healthcare Medicare |
$190.74
|
| Rate for Payer: WINHealth Partners Commercial |
$274.55
|
| Rate for Payer: Wise Provider Network Commercial |
$274.55
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
7612562201
|
|
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 CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
7612562201
|
|
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 CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
7612354501
|
|
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 CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
5102354501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.74 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$296.64
|
| Rate for Payer: Altius Commercial |
$296.64
|
| Rate for Payer: Beech Street Commercial |
$302.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.69
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.73
|
| Rate for Payer: Cigna of WY Commercial |
$302.82
|
| Rate for Payer: Entrust Commercial |
$293.55
|
| Rate for Payer: First Choice Health Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.94
|
| Rate for Payer: HealthUtah PPO |
$309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.73
|
| Rate for Payer: Multiplan Medicare/VA |
$193.74
|
| Rate for Payer: One Health Plan of WY PPO |
$302.82
|
| Rate for Payer: PacificSource Commercial |
$278.10
|
| Rate for Payer: PHCS PPO |
$302.82
|
| Rate for Payer: Three Rivers PPO |
$231.75
|
| Rate for Payer: TriWest Veterans Administration |
$203.94
|
| Rate for Payer: United Healthcare Commercial |
$268.83
|
| Rate for Payer: United Healthcare Medicare |
$203.94
|
| Rate for Payer: WINHealth Partners Commercial |
$293.55
|
| Rate for Payer: Wise Provider Network Commercial |
$293.55
|
|
|
HC CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
7612354501
|
|
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 CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
5102354501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.26 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.82
|
| Rate for Payer: Aetna of WY Medicare |
$203.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$296.64
|
| Rate for Payer: Altius Commercial |
$296.64
|
| Rate for Payer: Beech Street Commercial |
$302.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.69
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.73
|
| Rate for Payer: Cigna of WY Commercial |
$302.82
|
| Rate for Payer: Entrust Commercial |
$293.55
|
| Rate for Payer: First Choice Health Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.22
|
| Rate for Payer: HealthUtah PPO |
$309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.73
|
| Rate for Payer: Multiplan Medicare/VA |
$170.26
|
| Rate for Payer: One Health Plan of WY PPO |
$302.82
|
| Rate for Payer: PacificSource Commercial |
$278.10
|
| Rate for Payer: PHCS PPO |
$302.82
|
| Rate for Payer: Three Rivers PPO |
$231.75
|
| Rate for Payer: TriWest Veterans Administration |
$179.22
|
| Rate for Payer: United Healthcare Commercial |
$268.83
|
| Rate for Payer: United Healthcare Medicare |
$179.22
|
| Rate for Payer: WINHealth Partners Commercial |
$302.82
|
| Rate for Payer: Wise Provider Network Commercial |
$293.55
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
7612350001
|
|
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 CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
5102350001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$616.57 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,096.62
|
| Rate for Payer: Aetna of WY Medicare |
$738.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,074.24
|
| Rate for Payer: Altius Commercial |
$1,074.24
|
| Rate for Payer: Beech Street Commercial |
$1,096.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$918.70
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,085.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,096.62
|
| Rate for Payer: Entrust Commercial |
$1,063.05
|
| Rate for Payer: First Choice Health Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.02
|
| Rate for Payer: HealthUtah PPO |
$1,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,085.43
|
| Rate for Payer: Multiplan Medicare/VA |
$616.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,096.62
|
| Rate for Payer: PacificSource Commercial |
$1,007.10
|
| Rate for Payer: PHCS PPO |
$1,096.62
|
| Rate for Payer: Three Rivers PPO |
$839.25
|
| Rate for Payer: TriWest Veterans Administration |
$649.02
|
| Rate for Payer: United Healthcare Commercial |
$973.53
|
| Rate for Payer: United Healthcare Medicare |
$649.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,096.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,063.05
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
5102350001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$701.61 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,096.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,074.24
|
| Rate for Payer: Altius Commercial |
$1,074.24
|
| Rate for Payer: Beech Street Commercial |
$1,096.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$918.70
|
| Rate for Payer: Cash Price |
$783.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,085.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,096.62
|
| Rate for Payer: Entrust Commercial |
$1,063.05
|
| Rate for Payer: First Choice Health Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,063.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.54
|
| Rate for Payer: HealthUtah PPO |
$1,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,085.43
|
| Rate for Payer: Multiplan Medicare/VA |
$701.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,096.62
|
| Rate for Payer: PacificSource Commercial |
$1,007.10
|
| Rate for Payer: PHCS PPO |
$1,096.62
|
| Rate for Payer: Three Rivers PPO |
$839.25
|
| Rate for Payer: TriWest Veterans Administration |
$738.54
|
| Rate for Payer: United Healthcare Commercial |
$973.53
|
| Rate for Payer: United Healthcare Medicare |
$738.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,063.05
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
7612350001
|
|
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 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
5102567501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.62 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$415.52
|
| Rate for Payer: Aetna of WY Medicare |
$279.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$407.04
|
| Rate for Payer: Altius Commercial |
$407.04
|
| Rate for Payer: Beech Street Commercial |
$415.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.10
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$411.28
|
| Rate for Payer: Cigna of WY Commercial |
$415.52
|
| Rate for Payer: Entrust Commercial |
$402.80
|
| Rate for Payer: First Choice Health Commercial |
$402.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$402.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.92
|
| Rate for Payer: HealthUtah PPO |
$424.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$411.28
|
| Rate for Payer: Multiplan Medicare/VA |
$233.62
|
| Rate for Payer: One Health Plan of WY PPO |
$415.52
|
| Rate for Payer: PacificSource Commercial |
$381.60
|
| Rate for Payer: PHCS PPO |
$415.52
|
| Rate for Payer: Three Rivers PPO |
$318.00
|
| Rate for Payer: TriWest Veterans Administration |
$245.92
|
| Rate for Payer: United Healthcare Commercial |
$368.88
|
| Rate for Payer: United Healthcare Medicare |
$245.92
|
| Rate for Payer: WINHealth Partners Commercial |
$415.52
|
| Rate for Payer: Wise Provider Network Commercial |
$402.80
|
|
|
HC CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
5102567501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.85 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$415.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$407.04
|
| Rate for Payer: Altius Commercial |
$407.04
|
| Rate for Payer: Beech Street Commercial |
$415.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$348.10
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$411.28
|
| Rate for Payer: Cigna of WY Commercial |
$415.52
|
| Rate for Payer: Entrust Commercial |
$402.80
|
| Rate for Payer: First Choice Health Commercial |
$402.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$402.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.84
|
| Rate for Payer: HealthUtah PPO |
$424.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$411.28
|
| Rate for Payer: Multiplan Medicare/VA |
$265.85
|
| Rate for Payer: One Health Plan of WY PPO |
$415.52
|
| Rate for Payer: PacificSource Commercial |
$381.60
|
| Rate for Payer: PHCS PPO |
$415.52
|
| Rate for Payer: Three Rivers PPO |
$318.00
|
| Rate for Payer: TriWest Veterans Administration |
$279.84
|
| Rate for Payer: United Healthcare Commercial |
$368.88
|
| Rate for Payer: United Healthcare Medicare |
$279.84
|
| Rate for Payer: WINHealth Partners Commercial |
$402.80
|
| Rate for Payer: Wise Provider Network Commercial |
$402.80
|
|
