|
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
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
5102550501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.50 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$345.94
|
| Rate for Payer: Aetna of WY Medicare |
$232.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$338.88
|
| Rate for Payer: Altius Commercial |
$338.88
|
| Rate for Payer: Beech Street Commercial |
$345.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.81
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$342.41
|
| Rate for Payer: Cigna of WY Commercial |
$345.94
|
| Rate for Payer: Entrust Commercial |
$335.35
|
| Rate for Payer: First Choice Health Commercial |
$335.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$335.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.74
|
| Rate for Payer: HealthUtah PPO |
$353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$342.41
|
| Rate for Payer: Multiplan Medicare/VA |
$194.50
|
| Rate for Payer: One Health Plan of WY PPO |
$345.94
|
| Rate for Payer: PacificSource Commercial |
$317.70
|
| Rate for Payer: PHCS PPO |
$345.94
|
| Rate for Payer: Three Rivers PPO |
$264.75
|
| Rate for Payer: TriWest Veterans Administration |
$204.74
|
| Rate for Payer: United Healthcare Commercial |
$307.11
|
| Rate for Payer: United Healthcare Medicare |
$204.74
|
| Rate for Payer: WINHealth Partners Commercial |
$345.94
|
| Rate for Payer: Wise Provider Network Commercial |
$335.35
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
5102550501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.33 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$345.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$338.88
|
| Rate for Payer: Altius Commercial |
$338.88
|
| Rate for Payer: Beech Street Commercial |
$345.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$289.81
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$342.41
|
| Rate for Payer: Cigna of WY Commercial |
$345.94
|
| Rate for Payer: Entrust Commercial |
$335.35
|
| Rate for Payer: First Choice Health Commercial |
$335.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$335.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.98
|
| Rate for Payer: HealthUtah PPO |
$353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$342.41
|
| Rate for Payer: Multiplan Medicare/VA |
$221.33
|
| Rate for Payer: One Health Plan of WY PPO |
$345.94
|
| Rate for Payer: PacificSource Commercial |
$317.70
|
| Rate for Payer: PHCS PPO |
$345.94
|
| Rate for Payer: Three Rivers PPO |
$264.75
|
| Rate for Payer: TriWest Veterans Administration |
$232.98
|
| Rate for Payer: United Healthcare Commercial |
$307.11
|
| Rate for Payer: United Healthcare Medicare |
$232.98
|
| Rate for Payer: WINHealth Partners Commercial |
$335.35
|
| Rate for Payer: Wise Provider Network Commercial |
$335.35
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
5102550001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$173.76
|
| Rate for Payer: Altius Commercial |
$173.76
|
| Rate for Payer: Beech Street Commercial |
$177.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.60
|
| Rate for Payer: Cash Price |
$126.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.57
|
| Rate for Payer: Cigna of WY Commercial |
$177.38
|
| Rate for Payer: Entrust Commercial |
$171.95
|
| Rate for Payer: First Choice Health Commercial |
$171.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.46
|
| Rate for Payer: HealthUtah PPO |
$181.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.57
|
| Rate for Payer: Multiplan Medicare/VA |
$113.49
|
| Rate for Payer: One Health Plan of WY PPO |
$177.38
|
| Rate for Payer: PacificSource Commercial |
$162.90
|
| Rate for Payer: PHCS PPO |
$177.38
|
| Rate for Payer: Three Rivers PPO |
$135.75
|
| Rate for Payer: TriWest Veterans Administration |
$119.46
|
| Rate for Payer: United Healthcare Commercial |
$157.47
|
| Rate for Payer: United Healthcare Medicare |
$119.46
|
| Rate for Payer: WINHealth Partners Commercial |
$171.95
|
| Rate for Payer: Wise Provider Network Commercial |
$171.95
|
|
|
HC CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
5102550001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.38
|
| Rate for Payer: Aetna of WY Medicare |
$119.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$173.76
|
| Rate for Payer: Altius Commercial |
$173.76
|
| Rate for Payer: Beech Street Commercial |
$177.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.60
|
| Rate for Payer: Cash Price |
$126.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.57
|
| Rate for Payer: Cigna of WY Commercial |
$177.38
|
| Rate for Payer: Entrust Commercial |
$171.95
|
| Rate for Payer: First Choice Health Commercial |
$171.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$171.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.98
|
| Rate for Payer: HealthUtah PPO |
$181.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.57
|
| Rate for Payer: Multiplan Medicare/VA |
$99.73
|
| Rate for Payer: One Health Plan of WY PPO |
$177.38
|
| Rate for Payer: PacificSource Commercial |
$162.90
|
| Rate for Payer: PHCS PPO |
$177.38
|
| Rate for Payer: Three Rivers PPO |
$135.75
|
| Rate for Payer: TriWest Veterans Administration |
$104.98
|
| Rate for Payer: United Healthcare Commercial |
$157.47
|
| Rate for Payer: United Healthcare Medicare |
$104.98
|
| Rate for Payer: WINHealth Partners Commercial |
$177.38
|
| Rate for Payer: Wise Provider Network Commercial |
$171.95
|
|
|
HC CLOSED TX RADIAL SHAFT FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
7612550001
|
|
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 RADIAL SHAFT FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
7612550001
|
|
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 SHAFT FX,MANIPULATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
7612550501
|
|
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 SHAFT FX,MANIPULATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
7612550501
|
|
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&ULNAR SHAFT FRACTURES W/MANJ
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
5102556501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.63 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.92
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.27
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.82
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$79.63
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$83.82
|
| Rate for Payer: United Healthcare Commercial |
$110.49
|
| Rate for Payer: United Healthcare Medicare |
$83.82
|
| Rate for Payer: WINHealth Partners Commercial |
$120.65
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
5102556501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.98 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$124.46
|
| Rate for Payer: Aetna of WY Medicare |
$83.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$121.92
|
| Rate for Payer: Altius Commercial |
$121.92
|
| Rate for Payer: Beech Street Commercial |
$124.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.27
|
| Rate for Payer: Cash Price |
$88.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$123.19
|
| Rate for Payer: Cigna of WY Commercial |
$124.46
|
| Rate for Payer: Entrust Commercial |
$120.65
|
| Rate for Payer: First Choice Health Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$120.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.66
|
| Rate for Payer: HealthUtah PPO |
$127.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$123.19
|
| Rate for Payer: Multiplan Medicare/VA |
$69.98
|
| Rate for Payer: One Health Plan of WY PPO |
$124.46
|
| Rate for Payer: PacificSource Commercial |
$114.30
|
| Rate for Payer: PHCS PPO |
$124.46
|
| Rate for Payer: Three Rivers PPO |
$95.25
|
| Rate for Payer: TriWest Veterans Administration |
$73.66
|
| Rate for Payer: United Healthcare Commercial |
$110.49
|
| Rate for Payer: United Healthcare Medicare |
$73.66
|
| Rate for Payer: WINHealth Partners Commercial |
$124.46
|
| Rate for Payer: Wise Provider Network Commercial |
$120.65
|
|
|
HC CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
5102556001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$251.52
|
| Rate for Payer: Altius Commercial |
$251.52
|
| Rate for Payer: Beech Street Commercial |
$256.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.10
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: Entrust Commercial |
$248.90
|
| Rate for Payer: First Choice Health Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.92
|
| Rate for Payer: HealthUtah PPO |
$262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$164.27
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$256.76
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$172.92
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$172.92
|
| Rate for Payer: WINHealth Partners Commercial |
$248.90
|
| Rate for Payer: Wise Provider Network Commercial |
$248.90
|
|
|
HC CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
5102556001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Aetna of WY Medicare |
$172.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$251.52
|
| Rate for Payer: Altius Commercial |
$251.52
|
| Rate for Payer: Beech Street Commercial |
$256.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.10
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: Entrust Commercial |
$248.90
|
| Rate for Payer: First Choice Health Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.96
|
| Rate for Payer: HealthUtah PPO |
$262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$144.36
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$256.76
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$151.96
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$151.96
|
| Rate for Payer: WINHealth Partners Commercial |
$256.76
|
| Rate for Payer: Wise Provider Network Commercial |
$248.90
|
|
|
HC CLOSED TX RADIAL & ULNAR SHAFT FRACTURES W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
7612556001
|
|
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 & ULNAR SHAFT FRACTURES W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
7612556001
|
|
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 RAD/ULNA SHAFT FX,MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
7612556501
|
|
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 RAD/ULNA SHAFT FX,MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
7612556501
|
|
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 SCAPULA FX,MANIPULATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
7612357501
|
|
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 SCAPULA FX,MANIPULATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
7612357501
|
|
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 SCAPULAR FX W/O ANIPULATION
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
5102357001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$157.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$229.44
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.22
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.62
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$131.69
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$138.62
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$138.62
|
| Rate for Payer: WINHealth Partners Commercial |
$234.22
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC CLOSED TX SCAPULAR FX W/O ANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
7612357001
|
|
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 SCAPULAR FX W/O ANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
7612357001
|
|
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 SCAPULAR FX W/O ANIPULATION
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
5102357001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$229.44
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.22
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.74
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$149.85
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$157.74
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$157.74
|
| Rate for Payer: WINHealth Partners Commercial |
$227.05
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC CLOSED TX SHLDR DISLOC,ANESTHESIA
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
7612365501
|
|
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 SHLDR DISLOC,ANESTHESIA
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
7612365501
|
|
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
|
|
