|
HC CLOSED TX SHLDR DISLOCATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
7612365001
|
|
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 SHLDR DISLOCATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
7612365001
|
|
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 SHLDR DISLOC,GR TUB FX
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
7612366501
|
|
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 SHLDR DISLOC,GR TUB FX
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
7612366501
|
|
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 TALUS FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
5102843001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.06 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.22
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$136.06
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.22
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$143.22
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
5102843001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.86
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$119.57
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$125.86
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
HC CLOSED TX TALUS FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
7612843001
|
|
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 TALUS FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
7612843001
|
|
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 TALUS FX,MANIPULATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
7612843501
|
|
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 TALUS FX,MANIPULATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
7612843501
|
|
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 TARSOMETATARSAL DISLOCATION W/ANES
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
5102860501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.54 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.12
|
| Rate for Payer: Aetna of WY Medicare |
$227.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.24
|
| Rate for Payer: Altius Commercial |
$330.24
|
| Rate for Payer: Beech Street Commercial |
$337.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.42
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.68
|
| Rate for Payer: Cigna of WY Commercial |
$337.12
|
| Rate for Payer: Entrust Commercial |
$326.80
|
| Rate for Payer: First Choice Health Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.52
|
| Rate for Payer: HealthUtah PPO |
$344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.68
|
| Rate for Payer: Multiplan Medicare/VA |
$189.54
|
| Rate for Payer: One Health Plan of WY PPO |
$337.12
|
| Rate for Payer: PacificSource Commercial |
$309.60
|
| Rate for Payer: PHCS PPO |
$337.12
|
| Rate for Payer: Three Rivers PPO |
$258.00
|
| Rate for Payer: TriWest Veterans Administration |
$199.52
|
| Rate for Payer: United Healthcare Commercial |
$299.28
|
| Rate for Payer: United Healthcare Medicare |
$199.52
|
| Rate for Payer: WINHealth Partners Commercial |
$337.12
|
| Rate for Payer: Wise Provider Network Commercial |
$326.80
|
|
|
HC CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
7612860501
|
|
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 TARSOMETATARSAL DISLOCATION W/ANES
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
7612860501
|
|
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 TARSOMETATARSAL DISLOCATION W/ANES
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
5102860501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.69 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.24
|
| Rate for Payer: Altius Commercial |
$330.24
|
| Rate for Payer: Beech Street Commercial |
$337.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.42
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.68
|
| Rate for Payer: Cigna of WY Commercial |
$337.12
|
| Rate for Payer: Entrust Commercial |
$326.80
|
| Rate for Payer: First Choice Health Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.04
|
| Rate for Payer: HealthUtah PPO |
$344.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.68
|
| Rate for Payer: Multiplan Medicare/VA |
$215.69
|
| Rate for Payer: One Health Plan of WY PPO |
$337.12
|
| Rate for Payer: PacificSource Commercial |
$309.60
|
| Rate for Payer: PHCS PPO |
$337.12
|
| Rate for Payer: Three Rivers PPO |
$258.00
|
| Rate for Payer: TriWest Veterans Administration |
$227.04
|
| Rate for Payer: United Healthcare Commercial |
$299.28
|
| Rate for Payer: United Healthcare Medicare |
$227.04
|
| Rate for Payer: WINHealth Partners Commercial |
$326.80
|
| Rate for Payer: Wise Provider Network Commercial |
$326.80
|
|
|
HC CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 21485
|
| Hospital Charge Code |
5102148501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$515.18 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$916.30
|
| Rate for Payer: Aetna of WY Medicare |
$617.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$897.60
|
| Rate for Payer: Altius Commercial |
$897.60
|
| Rate for Payer: Beech Street Commercial |
$916.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$767.64
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$906.95
|
| Rate for Payer: Cigna of WY Commercial |
$916.30
|
| Rate for Payer: Entrust Commercial |
$888.25
|
| Rate for Payer: First Choice Health Commercial |
$888.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$888.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$542.30
|
| Rate for Payer: HealthUtah PPO |
$935.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$906.95
|
| Rate for Payer: Multiplan Medicare/VA |
$515.18
|
| Rate for Payer: One Health Plan of WY PPO |
$916.30
|
| Rate for Payer: PacificSource Commercial |
$841.50
|
| Rate for Payer: PHCS PPO |
$916.30
|
| Rate for Payer: Three Rivers PPO |
$701.25
|
| Rate for Payer: TriWest Veterans Administration |
$542.30
|
| Rate for Payer: United Healthcare Commercial |
$813.45
|
| Rate for Payer: United Healthcare Medicare |
$542.30
|
| Rate for Payer: WINHealth Partners Commercial |
$916.30
|
| Rate for Payer: Wise Provider Network Commercial |
$888.25
|
|
|
HC CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 21485
|
| Hospital Charge Code |
5102148501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$586.24 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$916.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$897.60
|
| Rate for Payer: Altius Commercial |
$897.60
|
| Rate for Payer: Beech Street Commercial |
$916.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$767.64
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$906.95
|
| Rate for Payer: Cigna of WY Commercial |
$916.30
|
| Rate for Payer: Entrust Commercial |
$888.25
|
| Rate for Payer: First Choice Health Commercial |
$888.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$888.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.10
|
| Rate for Payer: HealthUtah PPO |
$935.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$906.95
|
| Rate for Payer: Multiplan Medicare/VA |
$586.24
|
| Rate for Payer: One Health Plan of WY PPO |
$916.30
|
| Rate for Payer: PacificSource Commercial |
$841.50
|
| Rate for Payer: PHCS PPO |
$916.30
|
| Rate for Payer: Three Rivers PPO |
$701.25
|
| Rate for Payer: TriWest Veterans Administration |
$617.10
|
| Rate for Payer: United Healthcare Commercial |
$813.45
|
| Rate for Payer: United Healthcare Medicare |
$617.10
|
| Rate for Payer: WINHealth Partners Commercial |
$888.25
|
| Rate for Payer: Wise Provider Network Commercial |
$888.25
|
|
|
HC CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
5102148001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
5102148001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC CLOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
5102753001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.44 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$287.14
|
| Rate for Payer: Aetna of WY Medicare |
$193.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$281.28
|
| Rate for Payer: Altius Commercial |
$281.28
|
| Rate for Payer: Beech Street Commercial |
$287.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$240.55
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$284.21
|
| Rate for Payer: Cigna of WY Commercial |
$287.14
|
| Rate for Payer: Entrust Commercial |
$278.35
|
| Rate for Payer: First Choice Health Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.94
|
| Rate for Payer: HealthUtah PPO |
$293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$284.21
|
| Rate for Payer: Multiplan Medicare/VA |
$161.44
|
| Rate for Payer: One Health Plan of WY PPO |
$287.14
|
| Rate for Payer: PacificSource Commercial |
$263.70
|
| Rate for Payer: PHCS PPO |
$287.14
|
| Rate for Payer: Three Rivers PPO |
$219.75
|
| Rate for Payer: TriWest Veterans Administration |
$169.94
|
| Rate for Payer: United Healthcare Commercial |
$254.91
|
| Rate for Payer: United Healthcare Medicare |
$169.94
|
| Rate for Payer: WINHealth Partners Commercial |
$287.14
|
| Rate for Payer: Wise Provider Network Commercial |
$278.35
|
|
|
HC CLOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
5102753001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.71 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$287.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$281.28
|
| Rate for Payer: Altius Commercial |
$281.28
|
| Rate for Payer: Beech Street Commercial |
$287.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$240.55
|
| Rate for Payer: Cash Price |
$205.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$284.21
|
| Rate for Payer: Cigna of WY Commercial |
$287.14
|
| Rate for Payer: Entrust Commercial |
$278.35
|
| Rate for Payer: First Choice Health Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$278.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.38
|
| Rate for Payer: HealthUtah PPO |
$293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$284.21
|
| Rate for Payer: Multiplan Medicare/VA |
$183.71
|
| Rate for Payer: One Health Plan of WY PPO |
$287.14
|
| Rate for Payer: PacificSource Commercial |
$263.70
|
| Rate for Payer: PHCS PPO |
$287.14
|
| Rate for Payer: Three Rivers PPO |
$219.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.38
|
| Rate for Payer: United Healthcare Commercial |
$254.91
|
| Rate for Payer: United Healthcare Medicare |
$193.38
|
| Rate for Payer: WINHealth Partners Commercial |
$278.35
|
| Rate for Payer: Wise Provider Network Commercial |
$278.35
|
|
|
HC CLOSED TX TIBIAL PLATEAU FX
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
7612753001
|
|
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 TIBIAL PLATEAU FX
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
7612753001
|
|
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 TIBIA SHAFT FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
7612775001
|
|
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 TIBIA SHAFT FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
7612775001
|
|
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 TIBIA SHAFT FX,MANIPULATN
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
7612775201
|
|
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
|
|
