|
HC CLOSED TX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
5102677501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.57 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$333.12
|
| Rate for Payer: Altius Commercial |
$333.12
|
| Rate for Payer: Beech Street Commercial |
$340.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.89
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: Entrust Commercial |
$329.65
|
| Rate for Payer: First Choice Health Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.02
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$217.57
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$340.06
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.02
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$229.02
|
| Rate for Payer: WINHealth Partners Commercial |
$329.65
|
| Rate for Payer: Wise Provider Network Commercial |
$329.65
|
|
|
HC CLOSED TX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
7612677501
|
|
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 IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
5102677501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Medicare |
$229.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$333.12
|
| Rate for Payer: Altius Commercial |
$333.12
|
| Rate for Payer: Beech Street Commercial |
$340.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$284.89
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: Entrust Commercial |
$329.65
|
| Rate for Payer: First Choice Health Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.26
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$191.20
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$340.06
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$201.26
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$201.26
|
| Rate for Payer: WINHealth Partners Commercial |
$340.06
|
| Rate for Payer: Wise Provider Network Commercial |
$329.65
|
|
|
HC CLOSED TX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26775
|
| Hospital Charge Code |
7612677501
|
|
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 IP JT DISLOCATION
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
5102677001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$199.68
|
| Rate for Payer: Altius Commercial |
$199.68
|
| Rate for Payer: Beech Street Commercial |
$203.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$170.77
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: Entrust Commercial |
$197.60
|
| Rate for Payer: First Choice Health Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$137.28
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$130.42
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$203.84
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$137.28
|
| Rate for Payer: United Healthcare Commercial |
$180.96
|
| Rate for Payer: United Healthcare Medicare |
$137.28
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
| Rate for Payer: Wise Provider Network Commercial |
$197.60
|
|
|
HC CLOSED TX IP JT DISLOCATION
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
5102677001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.61 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$137.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$199.68
|
| Rate for Payer: Altius Commercial |
$199.68
|
| Rate for Payer: Beech Street Commercial |
$203.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$170.77
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: Entrust Commercial |
$197.60
|
| Rate for Payer: First Choice Health Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.64
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$114.61
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$203.84
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$120.64
|
| Rate for Payer: United Healthcare Commercial |
$180.96
|
| Rate for Payer: United Healthcare Medicare |
$120.64
|
| Rate for Payer: WINHealth Partners Commercial |
$203.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.60
|
|
|
HC CLOSED TX IP JT DISLOCATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
7612677001
|
|
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 IP JT DISLOCATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
7612677001
|
|
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 I-P JT,TOE DISLOCATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
7612866001
|
|
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 I-P JT,TOE DISLOCATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
7612866001
|
|
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 KNEECAP DISLOCATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
7612756001
|
|
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 KNEECAP DISLOCATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
7612756001
|
|
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 KNEE DISLOCATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
7612755001
|
|
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 KNEE DISLOCATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
7612755001
|
|
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 MC-P DISLOC
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
7612670001
|
|
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 MC-P DISLOC
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
7612670001
|
|
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 MED MALLEOLUS FX,MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
7612776201
|
|
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 MED MALLEOLUS FX,MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
7612776201
|
|
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 METACARPAL FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
7612660001
|
|
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 METACARPAL FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
7612660001
|
|
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 METACARPAL FX,MANIP
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
7612660501
|
|
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 METACARPAL FX,MANIP
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
7612660501
|
|
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 METACARPAL FX WO MANIP
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
5102660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$89.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.56
|
| Rate for Payer: Altius Commercial |
$130.56
|
| Rate for Payer: Beech Street Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.66
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: Entrust Commercial |
$129.20
|
| Rate for Payer: First Choice Health Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.88
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$74.94
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$133.28
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.88
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$78.88
|
| Rate for Payer: WINHealth Partners Commercial |
$133.28
|
| Rate for Payer: Wise Provider Network Commercial |
$129.20
|
|
|
HC CLOSED TX METACARPAL FX WO MANIP
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
5102660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.56
|
| Rate for Payer: Altius Commercial |
$130.56
|
| Rate for Payer: Beech Street Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.66
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: Entrust Commercial |
$129.20
|
| Rate for Payer: First Choice Health Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.76
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$85.27
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$133.28
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$89.76
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$89.76
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
| Rate for Payer: Wise Provider Network Commercial |
$129.20
|
|
|
HC CLOSED TX METATARSAL FX W/O MANIPULATION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
