|
HC CLOSED TX POST HIP ARTHRP DISLC REQ W/ANESTH
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
7612726601
|
|
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 POST HIP ARTHRP DISLC REQ W/ANESTH
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
7612726601
|
|
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 POST HIP ARTHRPLAS DISLOC
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
7612726501
|
|
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 POST HIP ARTHRPLAS DISLOC
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
7612726501
|
|
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 PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
7612778001
|
|
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 PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$1,451.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$909.78 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,392.96
|
| Rate for Payer: Altius Commercial |
$1,392.96
|
| Rate for Payer: Beech Street Commercial |
$1,421.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,191.27
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: Entrust Commercial |
$1,378.45
|
| Rate for Payer: First Choice Health Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$957.66
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$909.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PHCS PPO |
$1,421.98
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$957.66
|
| Rate for Payer: United Healthcare Commercial |
$1,262.37
|
| Rate for Payer: United Healthcare Medicare |
$957.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,378.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,378.45
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS 27780 50
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,599.00 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,843.96
|
| Rate for Payer: Aetna of WY Medicare |
$1,915.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,785.92
|
| Rate for Payer: Altius Commercial |
$2,785.92
|
| Rate for Payer: Beech Street Commercial |
$2,843.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,382.54
|
| Rate for Payer: Cash Price |
$2,031.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,814.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,843.96
|
| Rate for Payer: Entrust Commercial |
$2,756.90
|
| Rate for Payer: First Choice Health Commercial |
$2,756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,683.16
|
| Rate for Payer: HealthUtah PPO |
$2,902.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,814.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,599.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,843.96
|
| Rate for Payer: PacificSource Commercial |
$2,611.80
|
| Rate for Payer: PHCS PPO |
$2,843.96
|
| Rate for Payer: Three Rivers PPO |
$2,176.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,683.16
|
| Rate for Payer: United Healthcare Commercial |
$2,524.74
|
| Rate for Payer: United Healthcare Medicare |
$1,683.16
|
| Rate for Payer: WINHealth Partners Commercial |
$2,843.96
|
| Rate for Payer: Wise Provider Network Commercial |
$2,756.90
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
7612778001
|
|
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 PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS 27780 50
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,819.55 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,843.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,785.92
|
| Rate for Payer: Altius Commercial |
$2,785.92
|
| Rate for Payer: Beech Street Commercial |
$2,843.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,382.54
|
| Rate for Payer: Cash Price |
$2,031.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,814.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,843.96
|
| Rate for Payer: Entrust Commercial |
$2,756.90
|
| Rate for Payer: First Choice Health Commercial |
$2,756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,756.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,915.32
|
| Rate for Payer: HealthUtah PPO |
$2,902.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,814.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,819.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2,843.96
|
| Rate for Payer: PacificSource Commercial |
$2,611.80
|
| Rate for Payer: PHCS PPO |
$2,843.96
|
| Rate for Payer: Three Rivers PPO |
$2,176.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,915.32
|
| Rate for Payer: United Healthcare Commercial |
$2,524.74
|
| Rate for Payer: United Healthcare Medicare |
$1,915.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2,756.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2,756.90
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$1,451.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$799.50 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Aetna of WY Medicare |
$957.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,392.96
|
| Rate for Payer: Altius Commercial |
$1,392.96
|
| Rate for Payer: Beech Street Commercial |
$1,421.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,191.27
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: Entrust Commercial |
$1,378.45
|
| Rate for Payer: First Choice Health Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$841.58
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$799.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PHCS PPO |
$1,421.98
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$841.58
|
| Rate for Payer: United Healthcare Commercial |
$1,262.37
|
| Rate for Payer: United Healthcare Medicare |
$841.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,421.98
|
| Rate for Payer: Wise Provider Network Commercial |
$1,378.45
|
|
|
HC CLOSED TX PROX HUMERUS FX,MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
7612360501
|
|
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 PROX HUMERUS FX,MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
7612360501
|
|
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 PROX HUMERUS FX W/O MANIPULATION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
5102360001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC CLOSED TX PROX HUMERUS FX W/O MANIPULATION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
5102360001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC CLOSED TX PROX HUMERUS FX W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
7612360001
|
|
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 PROX HUMERUS FX W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
7612360001
|
|
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 PROX/MID FING SHFT FX
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
5102672001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.06
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$119.76
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.06
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$126.06
|
| Rate for Payer: WINHealth Partners Commercial |
$181.45
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC CLOSED TX PROX/MID FING SHFT FX
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
5102672001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.24 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$126.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.78
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$105.24
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$110.78
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$110.78
|
| Rate for Payer: WINHealth Partners Commercial |
$187.18
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC CLOSED TX RADIAL HEAD DISLOC,CHILD
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
7612464001
|
|
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 RADIAL HEAD DISLOC,CHILD
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
7612464001
|
|
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 RADIAL HEAD/NECK FX W/MANIPULATION
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
5102465501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$394.56
|
| Rate for Payer: Altius Commercial |
$394.56
|
| Rate for Payer: Beech Street Commercial |
$402.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$337.43
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: Entrust Commercial |
$390.45
|
| Rate for Payer: First Choice Health Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$271.26
|
| Rate for Payer: HealthUtah PPO |
$411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: Multiplan Medicare/VA |
$257.70
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$402.78
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: TriWest Veterans Administration |
$271.26
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: United Healthcare Medicare |
$271.26
|
| Rate for Payer: WINHealth Partners Commercial |
$390.45
|
| Rate for Payer: Wise Provider Network Commercial |
$390.45
|
|
|
HC CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
5102465501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.46 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Aetna of WY Medicare |
$271.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$394.56
|
| Rate for Payer: Altius Commercial |
$394.56
|
| Rate for Payer: Beech Street Commercial |
$402.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$337.43
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: Entrust Commercial |
$390.45
|
| Rate for Payer: First Choice Health Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$238.38
|
| Rate for Payer: HealthUtah PPO |
$411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: Multiplan Medicare/VA |
$226.46
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$402.78
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: TriWest Veterans Administration |
$238.38
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: United Healthcare Medicare |
$238.38
|
| Rate for Payer: WINHealth Partners Commercial |
$402.78
|
| Rate for Payer: Wise Provider Network Commercial |
$390.45
|
|
|
HC CLOSED TX RADIAL HEAD OR NECK FX W/O MANIPULATION
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
5102465001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.06
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$119.76
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.06
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$126.06
|
| Rate for Payer: WINHealth Partners Commercial |
$181.45
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
|
HC CLOSED TX RADIAL HEAD OR NECK FX W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
7612465001
|
|
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 RADIAL HEAD OR NECK FX W/O MANIPULATION
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
5102465001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.24 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$187.18
|
| Rate for Payer: Aetna of WY Medicare |
$126.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$183.36
|
| Rate for Payer: Altius Commercial |
$183.36
|
| Rate for Payer: Beech Street Commercial |
$187.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.81
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$185.27
|
| Rate for Payer: Cigna of WY Commercial |
$187.18
|
| Rate for Payer: Entrust Commercial |
$181.45
|
| Rate for Payer: First Choice Health Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$181.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.78
|
| Rate for Payer: HealthUtah PPO |
$191.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$185.27
|
| Rate for Payer: Multiplan Medicare/VA |
$105.24
|
| Rate for Payer: One Health Plan of WY PPO |
$187.18
|
| Rate for Payer: PacificSource Commercial |
$171.90
|
| Rate for Payer: PHCS PPO |
$187.18
|
| Rate for Payer: Three Rivers PPO |
$143.25
|
| Rate for Payer: TriWest Veterans Administration |
$110.78
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$110.78
|
| Rate for Payer: WINHealth Partners Commercial |
$187.18
|
| Rate for Payer: Wise Provider Network Commercial |
$181.45
|
|
