|
HC CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
5102722001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.34 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Aetna of WY Medicare |
$289.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$420.48
|
| Rate for Payer: Altius Commercial |
$420.48
|
| Rate for Payer: Beech Street Commercial |
$429.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: Entrust Commercial |
$416.10
|
| Rate for Payer: First Choice Health Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.04
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$241.34
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$429.24
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$254.04
|
| Rate for Payer: United Healthcare Commercial |
$381.06
|
| Rate for Payer: United Healthcare Medicare |
$254.04
|
| Rate for Payer: WINHealth Partners Commercial |
$429.24
|
| Rate for Payer: Wise Provider Network Commercial |
$416.10
|
|
|
HC CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
5102722001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$274.63 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$420.48
|
| Rate for Payer: Altius Commercial |
$420.48
|
| Rate for Payer: Beech Street Commercial |
$429.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$359.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: Entrust Commercial |
$416.10
|
| Rate for Payer: First Choice Health Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.08
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$274.63
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$429.24
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$289.08
|
| Rate for Payer: United Healthcare Commercial |
$381.06
|
| Rate for Payer: United Healthcare Medicare |
$289.08
|
| Rate for Payer: WINHealth Partners Commercial |
$416.10
|
| Rate for Payer: Wise Provider Network Commercial |
$416.10
|
|
|
HC CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
5102784201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.86
|
| Rate for Payer: Aetna of WY Medicare |
$334.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.72
|
| Rate for Payer: Altius Commercial |
$486.72
|
| Rate for Payer: Beech Street Commercial |
$496.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.25
|
| Rate for Payer: Cash Price |
$354.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.79
|
| Rate for Payer: Cigna of WY Commercial |
$496.86
|
| Rate for Payer: Entrust Commercial |
$481.65
|
| Rate for Payer: First Choice Health Commercial |
$481.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.06
|
| Rate for Payer: HealthUtah PPO |
$507.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.79
|
| Rate for Payer: Multiplan Medicare/VA |
$279.36
|
| Rate for Payer: One Health Plan of WY PPO |
$496.86
|
| Rate for Payer: PacificSource Commercial |
$456.30
|
| Rate for Payer: PHCS PPO |
$496.86
|
| Rate for Payer: Three Rivers PPO |
$380.25
|
| Rate for Payer: TriWest Veterans Administration |
$294.06
|
| Rate for Payer: United Healthcare Commercial |
$441.09
|
| Rate for Payer: United Healthcare Medicare |
$294.06
|
| Rate for Payer: WINHealth Partners Commercial |
$496.86
|
| Rate for Payer: Wise Provider Network Commercial |
$481.65
|
|
|
HC CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
5102784201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$317.89 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.72
|
| Rate for Payer: Altius Commercial |
$486.72
|
| Rate for Payer: Beech Street Commercial |
$496.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.25
|
| Rate for Payer: Cash Price |
$354.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.79
|
| Rate for Payer: Cigna of WY Commercial |
$496.86
|
| Rate for Payer: Entrust Commercial |
$481.65
|
| Rate for Payer: First Choice Health Commercial |
$481.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.62
|
| Rate for Payer: HealthUtah PPO |
$507.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.79
|
| Rate for Payer: Multiplan Medicare/VA |
$317.89
|
| Rate for Payer: One Health Plan of WY PPO |
$496.86
|
| Rate for Payer: PacificSource Commercial |
$456.30
|
| Rate for Payer: PHCS PPO |
$496.86
|
| Rate for Payer: Three Rivers PPO |
$380.25
|
| Rate for Payer: TriWest Veterans Administration |
$334.62
|
| Rate for Payer: United Healthcare Commercial |
$441.09
|
| Rate for Payer: United Healthcare Medicare |
$334.62
|
| Rate for Payer: WINHealth Partners Commercial |
$481.65
|
| Rate for Payer: Wise Provider Network Commercial |
$481.65
|
|
|
HC CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5102674201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$329.28
|
| Rate for Payer: Aetna of WY Medicare |
$221.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$322.56
|
| Rate for Payer: Altius Commercial |
$322.56
|
| Rate for Payer: Beech Street Commercial |
$329.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.86
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$325.92
|
| Rate for Payer: Cigna of WY Commercial |
$329.28
|
| Rate for Payer: Entrust Commercial |
$319.20
|
| Rate for Payer: First Choice Health Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.88
|
| Rate for Payer: HealthUtah PPO |
$336.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$325.92
|
| Rate for Payer: Multiplan Medicare/VA |
$185.14
|
| Rate for Payer: One Health Plan of WY PPO |
$329.28
|
| Rate for Payer: PacificSource Commercial |
$302.40
|
| Rate for Payer: PHCS PPO |
$329.28
|
| Rate for Payer: Three Rivers PPO |
$252.00
|
| Rate for Payer: TriWest Veterans Administration |
$194.88
|
| Rate for Payer: United Healthcare Commercial |
$292.32
|
| Rate for Payer: United Healthcare Medicare |
$194.88
|
| Rate for Payer: WINHealth Partners Commercial |
$329.28
|
| Rate for Payer: Wise Provider Network Commercial |
$319.20
|
|
|
HC CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
5102674201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.67 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$329.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$322.56
|
| Rate for Payer: Altius Commercial |
$322.56
|
| Rate for Payer: Beech Street Commercial |
$329.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$275.86
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$325.92
|
| Rate for Payer: Cigna of WY Commercial |
$329.28
|
| Rate for Payer: Entrust Commercial |
$319.20
|
| Rate for Payer: First Choice Health Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$319.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$221.76
|
| Rate for Payer: HealthUtah PPO |
$336.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$325.92
|
| Rate for Payer: Multiplan Medicare/VA |
$210.67
|
| Rate for Payer: One Health Plan of WY PPO |
$329.28
|
| Rate for Payer: PacificSource Commercial |
$302.40
|
| Rate for Payer: PHCS PPO |
$329.28
|
| Rate for Payer: Three Rivers PPO |
$252.00
|
| Rate for Payer: TriWest Veterans Administration |
$221.76
|
| Rate for Payer: United Healthcare Commercial |
$292.32
|
| Rate for Payer: United Healthcare Medicare |
$221.76
|
| Rate for Payer: WINHealth Partners Commercial |
$319.20
|
| Rate for Payer: Wise Provider Network Commercial |
$319.20
|
|
|
HC CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
5102674001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$209.28
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.88
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$136.69
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$143.88
|
| Rate for Payer: United Healthcare Commercial |
$189.66
|
| Rate for Payer: United Healthcare Medicare |
$143.88
|
| Rate for Payer: WINHealth Partners Commercial |
$207.10
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
5102674001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.64
|
| Rate for Payer: Aetna of WY Medicare |
$143.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$209.28
|
| Rate for Payer: Altius Commercial |
$209.28
|
| Rate for Payer: Beech Street Commercial |
$213.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$211.46
|
| Rate for Payer: Cigna of WY Commercial |
$213.64
|
| Rate for Payer: Entrust Commercial |
$207.10
|
| Rate for Payer: First Choice Health Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$207.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.44
|
| Rate for Payer: HealthUtah PPO |
$218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$211.46
|
| Rate for Payer: Multiplan Medicare/VA |
$120.12
|
| Rate for Payer: One Health Plan of WY PPO |
$213.64
|
| Rate for Payer: PacificSource Commercial |
$196.20
|
| Rate for Payer: PHCS PPO |
$213.64
|
| Rate for Payer: Three Rivers PPO |
$163.50
|
| Rate for Payer: TriWest Veterans Administration |
$126.44
|
| Rate for Payer: United Healthcare Commercial |
$189.66
|
| Rate for Payer: United Healthcare Medicare |
$126.44
|
| Rate for Payer: WINHealth Partners Commercial |
$213.64
|
| Rate for Payer: Wise Provider Network Commercial |
$207.10
|
|
|
HC CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
5102664501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.56 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$389.76
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$333.33
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.96
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$254.56
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$267.96
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$267.96
|
| Rate for Payer: WINHealth Partners Commercial |
$385.70
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
|
HC CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
5102664501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$267.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$389.76
|
| Rate for Payer: Altius Commercial |
$389.76
|
| Rate for Payer: Beech Street Commercial |
$397.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$333.33
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: Entrust Commercial |
$385.70
|
| Rate for Payer: First Choice Health Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$235.48
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$223.71
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$397.88
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$235.48
|
| Rate for Payer: WINHealth Partners Commercial |
$397.88
|
| Rate for Payer: Wise Provider Network Commercial |
$385.70
|
|
|
HC CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
5102667001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.88
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$199.39
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$209.88
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$209.88
|
| Rate for Payer: WINHealth Partners Commercial |
$302.10
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
5102667001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.22 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Aetna of WY Medicare |
$209.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.44
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$175.22
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$184.44
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$184.44
|
| Rate for Payer: WINHealth Partners Commercial |
$311.64
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
5102667501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.80
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$206.91
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$217.80
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
5102667501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$217.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$316.80
|
| Rate for Payer: Altius Commercial |
$316.80
|
| Rate for Payer: Beech Street Commercial |
$323.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$270.93
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: Entrust Commercial |
$313.50
|
| Rate for Payer: First Choice Health Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$323.40
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.40
|
| Rate for Payer: Wise Provider Network Commercial |
$313.50
|
|
|
HC CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
5102675501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.96
|
| Rate for Payer: Altius Commercial |
$168.96
|
| Rate for Payer: Beech Street Commercial |
$172.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.50
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: Entrust Commercial |
$167.20
|
| Rate for Payer: First Choice Health Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.16
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$110.35
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$172.48
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.16
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$116.16
|
| Rate for Payer: WINHealth Partners Commercial |
$167.20
|
| Rate for Payer: Wise Provider Network Commercial |
$167.20
|
|
|
HC CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
5102675501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$116.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.96
|
| Rate for Payer: Altius Commercial |
$168.96
|
| Rate for Payer: Beech Street Commercial |
$172.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$144.50
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: Entrust Commercial |
$167.20
|
| Rate for Payer: First Choice Health Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.08
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$96.98
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$172.48
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.08
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$102.08
|
| Rate for Payer: WINHealth Partners Commercial |
$172.48
|
| Rate for Payer: Wise Provider Network Commercial |
$167.20
|
|
|
HC CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
5102643201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.68 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$518.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$507.84
|
| Rate for Payer: Altius Commercial |
$507.84
|
| Rate for Payer: Beech Street Commercial |
$518.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$434.31
|
| Rate for Payer: Cash Price |
$370.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$513.13
|
| Rate for Payer: Cigna of WY Commercial |
$518.42
|
| Rate for Payer: Entrust Commercial |
$502.55
|
| Rate for Payer: First Choice Health Commercial |
$502.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$502.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.14
|
| Rate for Payer: HealthUtah PPO |
$529.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$513.13
|
| Rate for Payer: Multiplan Medicare/VA |
$331.68
|
| Rate for Payer: One Health Plan of WY PPO |
$518.42
|
| Rate for Payer: PacificSource Commercial |
$476.10
|
| Rate for Payer: PHCS PPO |
$518.42
|
| Rate for Payer: Three Rivers PPO |
$396.75
|
| Rate for Payer: TriWest Veterans Administration |
$349.14
|
| Rate for Payer: United Healthcare Commercial |
$460.23
|
| Rate for Payer: United Healthcare Medicare |
$349.14
|
| Rate for Payer: WINHealth Partners Commercial |
$502.55
|
| Rate for Payer: Wise Provider Network Commercial |
$502.55
|
|
|
HC CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
5102643201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$291.48 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$518.42
|
| Rate for Payer: Aetna of WY Medicare |
$349.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$507.84
|
| Rate for Payer: Altius Commercial |
$507.84
|
| Rate for Payer: Beech Street Commercial |
$518.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$434.31
|
| Rate for Payer: Cash Price |
$370.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$513.13
|
| Rate for Payer: Cigna of WY Commercial |
$518.42
|
| Rate for Payer: Entrust Commercial |
$502.55
|
| Rate for Payer: First Choice Health Commercial |
$502.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$502.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.82
|
| Rate for Payer: HealthUtah PPO |
$529.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$513.13
|
| Rate for Payer: Multiplan Medicare/VA |
$291.48
|
| Rate for Payer: One Health Plan of WY PPO |
$518.42
|
| Rate for Payer: PacificSource Commercial |
$476.10
|
| Rate for Payer: PHCS PPO |
$518.42
|
| Rate for Payer: Three Rivers PPO |
$396.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.82
|
| Rate for Payer: United Healthcare Commercial |
$460.23
|
| Rate for Payer: United Healthcare Medicare |
$306.82
|
| Rate for Payer: WINHealth Partners Commercial |
$518.42
|
| Rate for Payer: Wise Provider Network Commercial |
$502.55
|
|
|
HC CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
5102751001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.15 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$687.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$673.92
|
| Rate for Payer: Altius Commercial |
$673.92
|
| Rate for Payer: Beech Street Commercial |
$687.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$576.34
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$680.94
|
| Rate for Payer: Cigna of WY Commercial |
$687.96
|
| Rate for Payer: Entrust Commercial |
$666.90
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$463.32
|
| Rate for Payer: HealthUtah PPO |
$702.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$680.94
|
| Rate for Payer: Multiplan Medicare/VA |
$440.15
|
| Rate for Payer: One Health Plan of WY PPO |
$687.96
|
| Rate for Payer: PacificSource Commercial |
$631.80
|
| Rate for Payer: PHCS PPO |
$687.96
|
| Rate for Payer: Three Rivers PPO |
$526.50
|
| Rate for Payer: TriWest Veterans Administration |
$463.32
|
| Rate for Payer: United Healthcare Commercial |
$610.74
|
| Rate for Payer: United Healthcare Medicare |
$463.32
|
| Rate for Payer: WINHealth Partners Commercial |
$666.90
|
| Rate for Payer: Wise Provider Network Commercial |
$666.90
|
|
|
HC CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
5102751001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$386.80 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$687.96
|
| Rate for Payer: Aetna of WY Medicare |
$463.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$673.92
|
| Rate for Payer: Altius Commercial |
$673.92
|
| Rate for Payer: Beech Street Commercial |
$687.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$576.34
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$680.94
|
| Rate for Payer: Cigna of WY Commercial |
$687.96
|
| Rate for Payer: Entrust Commercial |
$666.90
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.16
|
| Rate for Payer: HealthUtah PPO |
$702.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$680.94
|
| Rate for Payer: Multiplan Medicare/VA |
$386.80
|
| Rate for Payer: One Health Plan of WY PPO |
$687.96
|
| Rate for Payer: PacificSource Commercial |
$631.80
|
| Rate for Payer: PHCS PPO |
$687.96
|
| Rate for Payer: Three Rivers PPO |
$526.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.16
|
| Rate for Payer: United Healthcare Commercial |
$610.74
|
| Rate for Payer: United Healthcare Medicare |
$407.16
|
| Rate for Payer: WINHealth Partners Commercial |
$687.96
|
| Rate for Payer: Wise Provider Network Commercial |
$666.90
|
|
|
HC CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
5102750801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.11 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$501.76
|
| Rate for Payer: Aetna of WY Medicare |
$337.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$491.52
|
| Rate for Payer: Altius Commercial |
$491.52
|
| Rate for Payer: Beech Street Commercial |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.35
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$496.64
|
| Rate for Payer: Cigna of WY Commercial |
$501.76
|
| Rate for Payer: Entrust Commercial |
$486.40
|
| Rate for Payer: First Choice Health Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$296.96
|
| Rate for Payer: HealthUtah PPO |
$512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$496.64
|
| Rate for Payer: Multiplan Medicare/VA |
$282.11
|
| Rate for Payer: One Health Plan of WY PPO |
$501.76
|
| Rate for Payer: PacificSource Commercial |
$460.80
|
| Rate for Payer: PHCS PPO |
$501.76
|
| Rate for Payer: Three Rivers PPO |
$384.00
|
| Rate for Payer: TriWest Veterans Administration |
$296.96
|
| Rate for Payer: United Healthcare Commercial |
$445.44
|
| Rate for Payer: United Healthcare Medicare |
$296.96
|
| Rate for Payer: WINHealth Partners Commercial |
$501.76
|
| Rate for Payer: Wise Provider Network Commercial |
$486.40
|
|
|
HC CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
5102750801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$321.02 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$501.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$491.52
|
| Rate for Payer: Altius Commercial |
$491.52
|
| Rate for Payer: Beech Street Commercial |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.35
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$496.64
|
| Rate for Payer: Cigna of WY Commercial |
$501.76
|
| Rate for Payer: Entrust Commercial |
$486.40
|
| Rate for Payer: First Choice Health Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$486.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$337.92
|
| Rate for Payer: HealthUtah PPO |
$512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$496.64
|
| Rate for Payer: Multiplan Medicare/VA |
$321.02
|
| Rate for Payer: One Health Plan of WY PPO |
$501.76
|
| Rate for Payer: PacificSource Commercial |
$460.80
|
| Rate for Payer: PHCS PPO |
$501.76
|
| Rate for Payer: Three Rivers PPO |
$384.00
|
| Rate for Payer: TriWest Veterans Administration |
$337.92
|
| Rate for Payer: United Healthcare Commercial |
$445.44
|
| Rate for Payer: United Healthcare Medicare |
$337.92
|
| Rate for Payer: WINHealth Partners Commercial |
$486.40
|
| Rate for Payer: Wise Provider Network Commercial |
$486.40
|
|
|
HC CLTX FEM FX PROX END NCK W/O MANJ
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
5102723001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC CLTX FEM FX PROX END NCK W/O MANJ
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
5102723001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
5102750201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$491.57 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$768.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$752.64
|
| Rate for Payer: Altius Commercial |
$752.64
|
| Rate for Payer: Beech Street Commercial |
$768.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$643.66
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$760.48
|
| Rate for Payer: Cigna of WY Commercial |
$768.32
|
| Rate for Payer: Entrust Commercial |
$744.80
|
| Rate for Payer: First Choice Health Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$744.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.44
|
| Rate for Payer: HealthUtah PPO |
$784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$760.48
|
| Rate for Payer: Multiplan Medicare/VA |
$491.57
|
| Rate for Payer: One Health Plan of WY PPO |
$768.32
|
| Rate for Payer: PacificSource Commercial |
$705.60
|
| Rate for Payer: PHCS PPO |
$768.32
|
| Rate for Payer: Three Rivers PPO |
$588.00
|
| Rate for Payer: TriWest Veterans Administration |
$517.44
|
| Rate for Payer: United Healthcare Commercial |
$682.08
|
| Rate for Payer: United Healthcare Medicare |
$517.44
|
| Rate for Payer: WINHealth Partners Commercial |
$744.80
|
| Rate for Payer: Wise Provider Network Commercial |
$744.80
|
|
