|
HC CLOSED TX DIST FIBULA FX
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
7612778601
|
|
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 DIST FIBULA FX
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
7612778601
|
|
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 DIST FIBULA FX,MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
7612778801
|
|
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 DIST FIBULA FX,MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
7612778801
|
|
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 DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 25605 50
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$423.17 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$752.64
|
| Rate for Payer: Aetna of WY Medicare |
$506.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$737.28
|
| Rate for Payer: Altius Commercial |
$737.28
|
| Rate for Payer: Beech Street Commercial |
$752.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$630.53
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$744.96
|
| Rate for Payer: Cigna of WY Commercial |
$752.64
|
| Rate for Payer: Entrust Commercial |
$729.60
|
| Rate for Payer: First Choice Health Commercial |
$729.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$729.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.44
|
| Rate for Payer: HealthUtah PPO |
$768.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$744.96
|
| Rate for Payer: Multiplan Medicare/VA |
$423.17
|
| Rate for Payer: One Health Plan of WY PPO |
$752.64
|
| Rate for Payer: PacificSource Commercial |
$691.20
|
| Rate for Payer: PHCS PPO |
$752.64
|
| Rate for Payer: Three Rivers PPO |
$576.00
|
| Rate for Payer: TriWest Veterans Administration |
$445.44
|
| Rate for Payer: United Healthcare Commercial |
$668.16
|
| Rate for Payer: United Healthcare Medicare |
$445.44
|
| Rate for Payer: WINHealth Partners Commercial |
$752.64
|
| Rate for Payer: Wise Provider Network Commercial |
$729.60
|
|
|
HC CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.77 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$368.64
|
| Rate for Payer: Altius Commercial |
$368.64
|
| Rate for Payer: Beech Street Commercial |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$315.26
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$372.48
|
| Rate for Payer: Cigna of WY Commercial |
$376.32
|
| Rate for Payer: Entrust Commercial |
$364.80
|
| Rate for Payer: First Choice Health Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.44
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$240.77
|
| Rate for Payer: One Health Plan of WY PPO |
$376.32
|
| Rate for Payer: PacificSource Commercial |
$345.60
|
| Rate for Payer: PHCS PPO |
$376.32
|
| Rate for Payer: Three Rivers PPO |
$288.00
|
| Rate for Payer: TriWest Veterans Administration |
$253.44
|
| Rate for Payer: United Healthcare Commercial |
$334.08
|
| Rate for Payer: United Healthcare Medicare |
$253.44
|
| Rate for Payer: WINHealth Partners Commercial |
$364.80
|
| Rate for Payer: Wise Provider Network Commercial |
$364.80
|
|
|
HC CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Aetna of WY Medicare |
$253.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$368.64
|
| Rate for Payer: Altius Commercial |
$368.64
|
| Rate for Payer: Beech Street Commercial |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$315.26
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$372.48
|
| Rate for Payer: Cigna of WY Commercial |
$376.32
|
| Rate for Payer: Entrust Commercial |
$364.80
|
| Rate for Payer: First Choice Health Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.72
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$211.58
|
| Rate for Payer: One Health Plan of WY PPO |
$376.32
|
| Rate for Payer: PacificSource Commercial |
$345.60
|
| Rate for Payer: PHCS PPO |
$376.32
|
| Rate for Payer: Three Rivers PPO |
$288.00
|
| Rate for Payer: TriWest Veterans Administration |
$222.72
|
| Rate for Payer: United Healthcare Commercial |
$334.08
|
| Rate for Payer: United Healthcare Medicare |
$222.72
|
| Rate for Payer: WINHealth Partners Commercial |
$376.32
|
| Rate for Payer: Wise Provider Network Commercial |
$364.80
|
|
|
HC CLOSED TX DISTIAL RADIAL FX/EPIPHYSEAL SEP ULNA W/ MANIPULATION
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 25605 50
|
| Hospital Charge Code |
5102560501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$481.54 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$752.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$737.28
|
| Rate for Payer: Altius Commercial |
$737.28
|
| Rate for Payer: Beech Street Commercial |
$752.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$630.53
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$744.96
|
| Rate for Payer: Cigna of WY Commercial |
$752.64
|
| Rate for Payer: Entrust Commercial |
$729.60
|
| Rate for Payer: First Choice Health Commercial |
$729.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$729.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$506.88
|
| Rate for Payer: HealthUtah PPO |
$768.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$744.96
|
| Rate for Payer: Multiplan Medicare/VA |
$481.54
|
| Rate for Payer: One Health Plan of WY PPO |
$752.64
|
| Rate for Payer: PacificSource Commercial |
$691.20
|
| Rate for Payer: PHCS PPO |
$752.64
|
| Rate for Payer: Three Rivers PPO |
$576.00
|
| Rate for Payer: TriWest Veterans Administration |
$506.88
|
| Rate for Payer: United Healthcare Commercial |
$668.16
|
| Rate for Payer: United Healthcare Medicare |
$506.88
|
| Rate for Payer: WINHealth Partners Commercial |
$729.60
|
| Rate for Payer: Wise Provider Network Commercial |
$729.60
|
|
|
HC CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.36
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$154.24
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$162.36
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$162.36
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 25600 50
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.86 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$471.36
|
| Rate for Payer: Altius Commercial |
$471.36
|
| Rate for Payer: Beech Street Commercial |
$481.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$403.11
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: Entrust Commercial |
$466.45
|
| Rate for Payer: First Choice Health Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.06
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$307.86
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$481.18
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$324.06
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$324.06
|
| Rate for Payer: WINHealth Partners Commercial |
$466.45
|
| Rate for Payer: Wise Provider Network Commercial |
$466.45
|
|
|
HC CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.68
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$135.55
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.68
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$142.68
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 25600 50
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.54 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$481.18
|
| Rate for Payer: Aetna of WY Medicare |
$324.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$471.36
|
| Rate for Payer: Altius Commercial |
$471.36
|
| Rate for Payer: Beech Street Commercial |
$481.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$403.11
|
| Rate for Payer: Cash Price |
$343.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$476.27
|
| Rate for Payer: Cigna of WY Commercial |
$481.18
|
| Rate for Payer: Entrust Commercial |
$466.45
|
| Rate for Payer: First Choice Health Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$466.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.78
|
| Rate for Payer: HealthUtah PPO |
$491.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$476.27
|
| Rate for Payer: Multiplan Medicare/VA |
$270.54
|
| Rate for Payer: One Health Plan of WY PPO |
$481.18
|
| Rate for Payer: PacificSource Commercial |
$441.90
|
| Rate for Payer: PHCS PPO |
$481.18
|
| Rate for Payer: Three Rivers PPO |
$368.25
|
| Rate for Payer: TriWest Veterans Administration |
$284.78
|
| Rate for Payer: United Healthcare Commercial |
$427.17
|
| Rate for Payer: United Healthcare Medicare |
$284.78
|
| Rate for Payer: WINHealth Partners Commercial |
$481.18
|
| Rate for Payer: Wise Provider Network Commercial |
$466.45
|
|
|
HC CLOSED TX DIST RAD/ULNA FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
7612560001
|
|
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 DIST RAD/ULNA FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
7612560001
|
|
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 DIST RAD/ULNA FX,MANIPUL
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
7612560501
|
|
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 DIST RAD/ULNA FX,MANIPUL
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
7612560501
|
|
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 DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
5102778601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$928.59 |
| Max. Negotiated Rate |
$1,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,451.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,421.76
|
| Rate for Payer: Altius Commercial |
$1,421.76
|
| Rate for Payer: Beech Street Commercial |
$1,451.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,215.90
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,436.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,451.38
|
| Rate for Payer: Entrust Commercial |
$1,406.95
|
| Rate for Payer: First Choice Health Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.46
|
| Rate for Payer: HealthUtah PPO |
$1,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,436.57
|
| Rate for Payer: Multiplan Medicare/VA |
$928.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,451.38
|
| Rate for Payer: PacificSource Commercial |
$1,332.90
|
| Rate for Payer: PHCS PPO |
$1,451.38
|
| Rate for Payer: Three Rivers PPO |
$1,110.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.46
|
| Rate for Payer: United Healthcare Commercial |
$1,288.47
|
| Rate for Payer: United Healthcare Medicare |
$977.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,406.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,406.95
|
|
|
HC CLOSED TX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
5102778601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$816.03 |
| Max. Negotiated Rate |
$1,481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,451.38
|
| Rate for Payer: Aetna of WY Medicare |
$977.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,421.76
|
| Rate for Payer: Altius Commercial |
$1,421.76
|
| Rate for Payer: Beech Street Commercial |
$1,451.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,215.90
|
| Rate for Payer: Cash Price |
$1,036.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,436.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,451.38
|
| Rate for Payer: Entrust Commercial |
$1,406.95
|
| Rate for Payer: First Choice Health Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,406.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$858.98
|
| Rate for Payer: HealthUtah PPO |
$1,481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,436.57
|
| Rate for Payer: Multiplan Medicare/VA |
$816.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,451.38
|
| Rate for Payer: PacificSource Commercial |
$1,332.90
|
| Rate for Payer: PHCS PPO |
$1,451.38
|
| Rate for Payer: Three Rivers PPO |
$1,110.75
|
| Rate for Payer: TriWest Veterans Administration |
$858.98
|
| Rate for Payer: United Healthcare Commercial |
$1,288.47
|
| Rate for Payer: United Healthcare Medicare |
$858.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,451.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,406.95
|
|
|
HC CLOSED TX DSTL TIBIA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
7612782401
|
|
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 DSTL TIBIA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
7612782401
|
|
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 ELBOW DISLOCATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
7612460001
|
|
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 ELBOW DISLOCATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
7612460001
|
|
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 ELBOW DISLOCATN,ANESTHESIA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
7612460501
|
|
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 ELBOW DISLOCATN,ANESTHESIA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
7612460501
|
|
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 FEMORAL FRACTURE PROX HEAD W/O MANJ
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
7612726701
|
|
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
|
|
