|
HC CLOSED TX TIBIA SHAFT FX,MANIPULATN
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27752
|
| Hospital Charge Code |
7612775201
|
|
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 TIBIA SHAFT FX W/O MANIP
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
HCPCS 27750 50
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$363.11 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$645.82
|
| Rate for Payer: Aetna of WY Medicare |
$434.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$632.64
|
| Rate for Payer: Altius Commercial |
$632.64
|
| Rate for Payer: Beech Street Commercial |
$645.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.04
|
| Rate for Payer: Cash Price |
$461.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$639.23
|
| Rate for Payer: Cigna of WY Commercial |
$645.82
|
| Rate for Payer: Entrust Commercial |
$626.05
|
| Rate for Payer: First Choice Health Commercial |
$626.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$626.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$382.22
|
| Rate for Payer: HealthUtah PPO |
$659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$639.23
|
| Rate for Payer: Multiplan Medicare/VA |
$363.11
|
| Rate for Payer: One Health Plan of WY PPO |
$645.82
|
| Rate for Payer: PacificSource Commercial |
$593.10
|
| Rate for Payer: PHCS PPO |
$645.82
|
| Rate for Payer: Three Rivers PPO |
$494.25
|
| Rate for Payer: TriWest Veterans Administration |
$382.22
|
| Rate for Payer: United Healthcare Commercial |
$573.33
|
| Rate for Payer: United Healthcare Medicare |
$382.22
|
| Rate for Payer: WINHealth Partners Commercial |
$645.82
|
| Rate for Payer: Wise Provider Network Commercial |
$626.05
|
|
|
HC CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
HCPCS 27750 50
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$413.19 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$645.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$632.64
|
| Rate for Payer: Altius Commercial |
$632.64
|
| Rate for Payer: Beech Street Commercial |
$645.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$541.04
|
| Rate for Payer: Cash Price |
$461.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$639.23
|
| Rate for Payer: Cigna of WY Commercial |
$645.82
|
| Rate for Payer: Entrust Commercial |
$626.05
|
| Rate for Payer: First Choice Health Commercial |
$626.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$626.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$434.94
|
| Rate for Payer: HealthUtah PPO |
$659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$639.23
|
| Rate for Payer: Multiplan Medicare/VA |
$413.19
|
| Rate for Payer: One Health Plan of WY PPO |
$645.82
|
| Rate for Payer: PacificSource Commercial |
$593.10
|
| Rate for Payer: PHCS PPO |
$645.82
|
| Rate for Payer: Three Rivers PPO |
$494.25
|
| Rate for Payer: TriWest Veterans Administration |
$434.94
|
| Rate for Payer: United Healthcare Commercial |
$573.33
|
| Rate for Payer: United Healthcare Medicare |
$434.94
|
| Rate for Payer: WINHealth Partners Commercial |
$626.05
|
| Rate for Payer: Wise Provider Network Commercial |
$626.05
|
|
|
HC CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$217.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$315.84
|
| Rate for Payer: Altius Commercial |
$315.84
|
| Rate for Payer: Beech Street Commercial |
$322.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.11
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: Entrust Commercial |
$312.55
|
| Rate for Payer: First Choice Health Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.82
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$181.28
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$322.42
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$190.82
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$190.82
|
| Rate for Payer: WINHealth Partners Commercial |
$322.42
|
| Rate for Payer: Wise Provider Network Commercial |
$312.55
|
|
|
HC CLOSED TX TIBIA SHAFT FX W/O MANIP
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.28 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$315.84
|
| Rate for Payer: Altius Commercial |
$315.84
|
| Rate for Payer: Beech Street Commercial |
$322.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.11
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: Entrust Commercial |
$312.55
|
| Rate for Payer: First Choice Health Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.14
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$206.28
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$322.42
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$217.14
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$217.14
|
| Rate for Payer: WINHealth Partners Commercial |
$312.55
|
| Rate for Payer: Wise Provider Network Commercial |
$312.55
|
|
|
HC CLOSED TX TOE FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
7612851001
|
|
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 TOE FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
7612851001
|
|
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 TOE FX,MANIPULATN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
7612851501
|
|
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 TOE FX,MANIPULATN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
7612851501
|
|
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 TRAUMA HIP DISLOC,ANESTH
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
7612725201
|
|
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 TRAUMA HIP DISLOC,ANESTH
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
7612725201
|
|
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 TRAUMATIC HIP DISLOCATN
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
7612725001
|
|
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 TRAUMATIC HIP DISLOCATN
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
7612725001
|
|
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 TRIMALLEOLAR FX,MANIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
7612781801
|
|
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 TRIMALLEOLAR FX,MANIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
7612781801
|
|
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 ULNAR FRACTURE PROX END W/O MANIPULATION
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
7612467001
|
|
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 ULNAR FRACTURE PROX END W/O MANIPULATION
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
7612467001
|
|
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 ULNAR FRACTURE PROXIMAL END W/MANJ
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
5102467501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.61 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$283.80
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$269.61
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$283.80
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$283.80
|
| Rate for Payer: WINHealth Partners Commercial |
$408.50
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
5102467501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Aetna of WY Medicare |
$283.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.40
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$236.93
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.40
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$249.40
|
| Rate for Payer: WINHealth Partners Commercial |
$421.40
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
5102467001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$262.08
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.13
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.18
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$171.17
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$180.18
|
| Rate for Payer: United Healthcare Commercial |
$237.51
|
| Rate for Payer: United Healthcare Medicare |
$180.18
|
| Rate for Payer: WINHealth Partners Commercial |
$259.35
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
5102467001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$267.54
|
| Rate for Payer: Aetna of WY Medicare |
$180.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$262.08
|
| Rate for Payer: Altius Commercial |
$262.08
|
| Rate for Payer: Beech Street Commercial |
$267.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.13
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$264.81
|
| Rate for Payer: Cigna of WY Commercial |
$267.54
|
| Rate for Payer: Entrust Commercial |
$259.35
|
| Rate for Payer: First Choice Health Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$259.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.34
|
| Rate for Payer: HealthUtah PPO |
$273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$264.81
|
| Rate for Payer: Multiplan Medicare/VA |
$150.42
|
| Rate for Payer: One Health Plan of WY PPO |
$267.54
|
| Rate for Payer: PacificSource Commercial |
$245.70
|
| Rate for Payer: PHCS PPO |
$267.54
|
| Rate for Payer: Three Rivers PPO |
$204.75
|
| Rate for Payer: TriWest Veterans Administration |
$158.34
|
| Rate for Payer: United Healthcare Commercial |
$237.51
|
| Rate for Payer: United Healthcare Medicare |
$158.34
|
| Rate for Payer: WINHealth Partners Commercial |
$267.54
|
| Rate for Payer: Wise Provider Network Commercial |
$259.35
|
|
|
HC CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
5102553001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$127.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$185.28
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.45
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.94
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$106.34
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$111.94
|
| Rate for Payer: United Healthcare Commercial |
$167.91
|
| Rate for Payer: United Healthcare Medicare |
$111.94
|
| Rate for Payer: WINHealth Partners Commercial |
$189.14
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
5102553001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.01 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$185.28
|
| Rate for Payer: Altius Commercial |
$185.28
|
| Rate for Payer: Beech Street Commercial |
$189.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.45
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: Entrust Commercial |
$183.35
|
| Rate for Payer: First Choice Health Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.38
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$121.01
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$189.14
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$127.38
|
| Rate for Payer: United Healthcare Commercial |
$167.91
|
| Rate for Payer: United Healthcare Medicare |
$127.38
|
| Rate for Payer: WINHealth Partners Commercial |
$183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$183.35
|
|
|
HC CLOSED TX ULNA SHAFT FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
7612553001
|
|
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 ULNA SHAFT FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
7612553001
|
|
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
|
|
