|
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
|
|
|
HC CLOSED TX METATARSAL FX W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
7612847001
|
|
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 METATARSAL FX W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
7612847001
|
|
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 MID HUMERUS FX,MANIPULATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
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 MID HUMERUS FX,MANIPULATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
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 MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
5102462001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.28 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$194.88
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.66
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.98
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$127.28
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$133.98
|
| Rate for Payer: United Healthcare Commercial |
$176.61
|
| Rate for Payer: United Healthcare Medicare |
$133.98
|
| Rate for Payer: WINHealth Partners Commercial |
$192.85
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
5102462001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.85 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.94
|
| Rate for Payer: Aetna of WY Medicare |
$133.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$194.88
|
| Rate for Payer: Altius Commercial |
$194.88
|
| Rate for Payer: Beech Street Commercial |
$198.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.66
|
| Rate for Payer: Cash Price |
$142.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.91
|
| Rate for Payer: Cigna of WY Commercial |
$198.94
|
| Rate for Payer: Entrust Commercial |
$192.85
|
| Rate for Payer: First Choice Health Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.74
|
| Rate for Payer: HealthUtah PPO |
$203.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.91
|
| Rate for Payer: Multiplan Medicare/VA |
$111.85
|
| Rate for Payer: One Health Plan of WY PPO |
$198.94
|
| Rate for Payer: PacificSource Commercial |
$182.70
|
| Rate for Payer: PHCS PPO |
$198.94
|
| Rate for Payer: Three Rivers PPO |
$152.25
|
| Rate for Payer: TriWest Veterans Administration |
$117.74
|
| Rate for Payer: United Healthcare Commercial |
$176.61
|
| Rate for Payer: United Healthcare Medicare |
$117.74
|
| Rate for Payer: WINHealth Partners Commercial |
$198.94
|
| Rate for Payer: Wise Provider Network Commercial |
$192.85
|
|
|
HC CLOSED TX MT-PHAL TOE DISLOCATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
7612863001
|
|
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 MT-PHAL TOE DISLOCATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
7612863001
|
|
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 NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
5102131501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.84
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.43
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.64
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$96.56
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$101.64
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$101.64
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
5102131501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$101.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.84
|
| Rate for Payer: Altius Commercial |
$147.84
|
| Rate for Payer: Beech Street Commercial |
$150.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.43
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: Entrust Commercial |
$146.30
|
| Rate for Payer: First Choice Health Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.32
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$84.85
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$150.92
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$89.32
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$89.32
|
| Rate for Payer: WINHealth Partners Commercial |
$150.92
|
| Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
7612131501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$443.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.76
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$370.27
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$389.76
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$389.76
|
| Rate for Payer: WINHealth Partners Commercial |
$658.56
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
7612131501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.52
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$421.34
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$443.52
|
| Rate for Payer: WINHealth Partners Commercial |
$638.40
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
5102132001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Aetna of WY Medicare |
$90.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$131.52
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.46
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$75.49
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$79.46
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: United Healthcare Medicare |
$79.46
|
| Rate for Payer: WINHealth Partners Commercial |
$134.26
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
5102132001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$131.52
|
| Rate for Payer: Altius Commercial |
$131.52
|
| Rate for Payer: Beech Street Commercial |
$134.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.89
|
| Rate for Payer: Cigna of WY Commercial |
$134.26
|
| Rate for Payer: Entrust Commercial |
$130.15
|
| Rate for Payer: First Choice Health Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.42
|
| Rate for Payer: HealthUtah PPO |
$137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.89
|
| Rate for Payer: Multiplan Medicare/VA |
$85.90
|
| Rate for Payer: One Health Plan of WY PPO |
$134.26
|
| Rate for Payer: PacificSource Commercial |
$123.30
|
| Rate for Payer: PHCS PPO |
$134.26
|
| Rate for Payer: Three Rivers PPO |
$102.75
|
| Rate for Payer: TriWest Veterans Administration |
$90.42
|
| Rate for Payer: United Healthcare Commercial |
$119.19
|
| Rate for Payer: United Healthcare Medicare |
$90.42
|
| Rate for Payer: WINHealth Partners Commercial |
$130.15
|
| Rate for Payer: Wise Provider Network Commercial |
$130.15
|
|
|
HC CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
5102133701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Aetna of WY Medicare |
$199.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$289.92
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.16
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$166.40
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$175.16
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: United Healthcare Medicare |
$175.16
|
| Rate for Payer: WINHealth Partners Commercial |
$295.96
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
5102133701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$289.92
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.32
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$189.35
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$262.74
|
| Rate for Payer: United Healthcare Medicare |
$199.32
|
| Rate for Payer: WINHealth Partners Commercial |
$286.90
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
7612756201
|
|
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 PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
7612756201
|
|
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 PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
5102756201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$276.60 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Aetna of WY Medicare |
$331.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$481.92
|
| Rate for Payer: Altius Commercial |
$481.92
|
| Rate for Payer: Beech Street Commercial |
$491.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.14
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: Entrust Commercial |
$476.90
|
| Rate for Payer: First Choice Health Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$291.16
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$276.60
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PHCS PPO |
$491.96
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$291.16
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Medicare |
$291.16
|
| Rate for Payer: WINHealth Partners Commercial |
$491.96
|
| Rate for Payer: Wise Provider Network Commercial |
$476.90
|
|
|
HC CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
5102756201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.75 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$481.92
|
| Rate for Payer: Altius Commercial |
$481.92
|
| Rate for Payer: Beech Street Commercial |
$491.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$412.14
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: Entrust Commercial |
$476.90
|
| Rate for Payer: First Choice Health Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.32
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$314.75
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PHCS PPO |
$491.96
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$331.32
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Medicare |
$331.32
|
| Rate for Payer: WINHealth Partners Commercial |
$476.90
|
| Rate for Payer: Wise Provider Network Commercial |
$476.90
|
|
|
HC CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
5102756001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$346.92
|
| Rate for Payer: Aetna of WY Medicare |
$233.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$339.84
|
| Rate for Payer: Altius Commercial |
$339.84
|
| Rate for Payer: Beech Street Commercial |
$346.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$290.63
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$343.38
|
| Rate for Payer: Cigna of WY Commercial |
$346.92
|
| Rate for Payer: Entrust Commercial |
$336.30
|
| Rate for Payer: First Choice Health Commercial |
$336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.32
|
| Rate for Payer: HealthUtah PPO |
$354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$343.38
|
| Rate for Payer: Multiplan Medicare/VA |
$195.05
|
| Rate for Payer: One Health Plan of WY PPO |
$346.92
|
| Rate for Payer: PacificSource Commercial |
$318.60
|
| Rate for Payer: PHCS PPO |
$346.92
|
| Rate for Payer: Three Rivers PPO |
$265.50
|
| Rate for Payer: TriWest Veterans Administration |
$205.32
|
| Rate for Payer: United Healthcare Commercial |
$307.98
|
| Rate for Payer: United Healthcare Medicare |
$205.32
|
| Rate for Payer: WINHealth Partners Commercial |
$346.92
|
| Rate for Payer: Wise Provider Network Commercial |
$336.30
|
|
|
HC CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
5102756001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$346.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$339.84
|
| Rate for Payer: Altius Commercial |
$339.84
|
| Rate for Payer: Beech Street Commercial |
$346.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$290.63
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$343.38
|
| Rate for Payer: Cigna of WY Commercial |
$346.92
|
| Rate for Payer: Entrust Commercial |
$336.30
|
| Rate for Payer: First Choice Health Commercial |
$336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$233.64
|
| Rate for Payer: HealthUtah PPO |
$354.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$343.38
|
| Rate for Payer: Multiplan Medicare/VA |
$221.96
|
| Rate for Payer: One Health Plan of WY PPO |
$346.92
|
| Rate for Payer: PacificSource Commercial |
$318.60
|
| Rate for Payer: PHCS PPO |
$346.92
|
| Rate for Payer: Three Rivers PPO |
$265.50
|
| Rate for Payer: TriWest Veterans Administration |
$233.64
|
| Rate for Payer: United Healthcare Commercial |
$307.98
|
| Rate for Payer: United Healthcare Medicare |
$233.64
|
| Rate for Payer: WINHealth Partners Commercial |
$336.30
|
| Rate for Payer: Wise Provider Network Commercial |
$336.30
|
|
|
HC CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
5102719701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.73 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$87.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.56
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$72.73
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$76.56
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$76.56
|
| Rate for Payer: WINHealth Partners Commercial |
$129.36
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
|
HC CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
5102719701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$126.72
|
| Rate for Payer: Altius Commercial |
$126.72
|
| Rate for Payer: Beech Street Commercial |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.37
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: Entrust Commercial |
$125.40
|
| Rate for Payer: First Choice Health Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.12
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$82.76
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$129.36
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.12
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$87.12
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
| Rate for Payer: Wise Provider Network Commercial |
$125.40
|
|
