|
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
|
|
|
HC CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
5102849501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.88
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.61
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.98
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$95.93
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$133.11
|
| Rate for Payer: United Healthcare Medicare |
$100.98
|
| Rate for Payer: WINHealth Partners Commercial |
$145.35
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
5102849501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.30 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$100.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.88
|
| Rate for Payer: Altius Commercial |
$146.88
|
| Rate for Payer: Beech Street Commercial |
$149.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.61
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: Entrust Commercial |
$145.35
|
| Rate for Payer: First Choice Health Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.74
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$84.30
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$149.94
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.74
|
| Rate for Payer: United Healthcare Commercial |
$133.11
|
| Rate for Payer: United Healthcare Medicare |
$88.74
|
| Rate for Payer: WINHealth Partners Commercial |
$149.94
|
| Rate for Payer: Wise Provider Network Commercial |
$145.35
|
|
|
HC CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
5102851501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
5102851501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
5102782401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.88 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.44
|
| Rate for Payer: Altius Commercial |
$301.44
|
| Rate for Payer: Beech Street Commercial |
$307.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.79
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: Entrust Commercial |
$298.30
|
| Rate for Payer: First Choice Health Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.24
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$196.88
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$307.72
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: TriWest Veterans Administration |
$207.24
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: United Healthcare Medicare |
$207.24
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
| Rate for Payer: Wise Provider Network Commercial |
$298.30
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
5102782401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.01 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Aetna of WY Medicare |
$207.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.44
|
| Rate for Payer: Altius Commercial |
$301.44
|
| Rate for Payer: Beech Street Commercial |
$307.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.79
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: Entrust Commercial |
$298.30
|
| Rate for Payer: First Choice Health Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.12
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$173.01
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$307.72
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: TriWest Veterans Administration |
$182.12
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: United Healthcare Medicare |
$182.12
|
| Rate for Payer: WINHealth Partners Commercial |
$307.72
|
| Rate for Payer: Wise Provider Network Commercial |
$298.30
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
5102782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
5102782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Facility
|
OP
|
$1,019.00
|
|
|
Service Code
|
HCPCS 27825 50
|
| Hospital Charge Code |
5102782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$561.47 |
| Max. Negotiated Rate |
$1,019.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$998.62
|
| Rate for Payer: Aetna of WY Medicare |
$672.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$978.24
|
| Rate for Payer: Altius Commercial |
$978.24
|
| Rate for Payer: Beech Street Commercial |
$998.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$836.60
|
| Rate for Payer: Cash Price |
$713.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$988.43
|
| Rate for Payer: Cigna of WY Commercial |
$998.62
|
| Rate for Payer: Entrust Commercial |
$968.05
|
| Rate for Payer: First Choice Health Commercial |
$968.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$968.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$591.02
|
| Rate for Payer: HealthUtah PPO |
$1,019.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$988.43
|
| Rate for Payer: Multiplan Medicare/VA |
$561.47
|
| Rate for Payer: One Health Plan of WY PPO |
$998.62
|
| Rate for Payer: PacificSource Commercial |
$917.10
|
| Rate for Payer: PHCS PPO |
$998.62
|
| Rate for Payer: Three Rivers PPO |
$764.25
|
| Rate for Payer: TriWest Veterans Administration |
$591.02
|
| Rate for Payer: United Healthcare Commercial |
$886.53
|
| Rate for Payer: United Healthcare Medicare |
$591.02
|
| Rate for Payer: WINHealth Partners Commercial |
$998.62
|
| Rate for Payer: Wise Provider Network Commercial |
$968.05
|
|
|
HC CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Facility
|
IP
|
$1,019.00
|
|
|
Service Code
|
HCPCS 27825 50
|
| Hospital Charge Code |
5102782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$638.91 |
| Max. Negotiated Rate |
$1,019.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$998.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$978.24
|
| Rate for Payer: Altius Commercial |
$978.24
|
| Rate for Payer: Beech Street Commercial |
$998.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$836.60
|
| Rate for Payer: Cash Price |
$713.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$988.43
|
| Rate for Payer: Cigna of WY Commercial |
$998.62
|
| Rate for Payer: Entrust Commercial |
$968.05
|
| Rate for Payer: First Choice Health Commercial |
$968.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$968.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$672.54
|
| Rate for Payer: HealthUtah PPO |
$1,019.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$988.43
|
| Rate for Payer: Multiplan Medicare/VA |
$638.91
|
| Rate for Payer: One Health Plan of WY PPO |
$998.62
|
| Rate for Payer: PacificSource Commercial |
$917.10
|
| Rate for Payer: PHCS PPO |
$998.62
|
| Rate for Payer: Three Rivers PPO |
$764.25
|
| Rate for Payer: TriWest Veterans Administration |
$672.54
|
| Rate for Payer: United Healthcare Commercial |
$886.53
|
| Rate for Payer: United Healthcare Medicare |
$672.54
|
| Rate for Payer: WINHealth Partners Commercial |
$968.05
|
| Rate for Payer: Wise Provider Network Commercial |
$968.05
|
|
|
HC CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
5102725201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$694.81 |
| Max. Negotiated Rate |
$1,261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,235.78
|
| Rate for Payer: Aetna of WY Medicare |
$832.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,210.56
|
| Rate for Payer: Altius Commercial |
$1,210.56
|
| Rate for Payer: Beech Street Commercial |
$1,235.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,035.28
|
| Rate for Payer: Cash Price |
$882.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,223.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,235.78
|
| Rate for Payer: Entrust Commercial |
$1,197.95
|
| Rate for Payer: First Choice Health Commercial |
$1,197.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.38
|
| Rate for Payer: HealthUtah PPO |
$1,261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,223.17
|
| Rate for Payer: Multiplan Medicare/VA |
$694.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,235.78
|
| Rate for Payer: PacificSource Commercial |
$1,134.90
|
| Rate for Payer: PHCS PPO |
$1,235.78
|
| Rate for Payer: Three Rivers PPO |
$945.75
|
| Rate for Payer: TriWest Veterans Administration |
$731.38
|
| Rate for Payer: United Healthcare Commercial |
$1,097.07
|
| Rate for Payer: United Healthcare Medicare |
$731.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,235.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.95
|
|
|
HC CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
5102725201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$790.65 |
| Max. Negotiated Rate |
$1,261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,235.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,210.56
|
| Rate for Payer: Altius Commercial |
$1,210.56
|
| Rate for Payer: Beech Street Commercial |
$1,235.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,035.28
|
| Rate for Payer: Cash Price |
$882.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,223.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,235.78
|
| Rate for Payer: Entrust Commercial |
$1,197.95
|
| Rate for Payer: First Choice Health Commercial |
$1,197.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,197.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$832.26
|
| Rate for Payer: HealthUtah PPO |
$1,261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,223.17
|
| Rate for Payer: Multiplan Medicare/VA |
$790.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1,235.78
|
| Rate for Payer: PacificSource Commercial |
$1,134.90
|
| Rate for Payer: PHCS PPO |
$1,235.78
|
| Rate for Payer: Three Rivers PPO |
$945.75
|
| Rate for Payer: TriWest Veterans Administration |
$832.26
|
| Rate for Payer: United Healthcare Commercial |
$1,097.07
|
| Rate for Payer: United Healthcare Medicare |
$832.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,197.95
|
|
|
HC CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5102457601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$125.40
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$132.00
|
| Rate for Payer: WINHealth Partners Commercial |
$190.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
5102457601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$132.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$192.00
|
| Rate for Payer: Altius Commercial |
$192.00
|
| Rate for Payer: Beech Street Commercial |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: Entrust Commercial |
$190.00
|
| Rate for Payer: First Choice Health Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.00
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$110.20
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$196.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicare |
$116.00
|
| Rate for Payer: WINHealth Partners Commercial |
$196.00
|
| Rate for Payer: Wise Provider Network Commercial |
$190.00
|
|
|
HC CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5102456001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.48
|
| Rate for Payer: Altius Commercial |
$108.48
|
| Rate for Payer: Beech Street Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.77
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: Entrust Commercial |
$107.35
|
| Rate for Payer: First Choice Health Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.58
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$70.85
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$110.74
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: TriWest Veterans Administration |
$74.58
|
| Rate for Payer: United Healthcare Commercial |
$98.31
|
| Rate for Payer: United Healthcare Medicare |
$74.58
|
| Rate for Payer: WINHealth Partners Commercial |
$107.35
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
|
HC CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
5102456001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.26 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Aetna of WY Medicare |
$74.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.48
|
| Rate for Payer: Altius Commercial |
$108.48
|
| Rate for Payer: Beech Street Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.77
|
| Rate for Payer: Cash Price |
$79.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.61
|
| Rate for Payer: Cigna of WY Commercial |
$110.74
|
| Rate for Payer: Entrust Commercial |
$107.35
|
| Rate for Payer: First Choice Health Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.54
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$62.26
|
| Rate for Payer: One Health Plan of WY PPO |
$110.74
|
| Rate for Payer: PacificSource Commercial |
$101.70
|
| Rate for Payer: PHCS PPO |
$110.74
|
| Rate for Payer: Three Rivers PPO |
$84.75
|
| Rate for Payer: TriWest Veterans Administration |
$65.54
|
| Rate for Payer: United Healthcare Commercial |
$98.31
|
| Rate for Payer: United Healthcare Medicare |
$65.54
|
| Rate for Payer: WINHealth Partners Commercial |
$110.74
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
|
HC CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
5102450501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$290.93 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$454.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$445.44
|
| Rate for Payer: Altius Commercial |
$445.44
|
| Rate for Payer: Beech Street Commercial |
$454.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$380.94
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$450.08
|
| Rate for Payer: Cigna of WY Commercial |
$454.72
|
| Rate for Payer: Entrust Commercial |
$440.80
|
| Rate for Payer: First Choice Health Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.24
|
| Rate for Payer: HealthUtah PPO |
$464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$450.08
|
| Rate for Payer: Multiplan Medicare/VA |
$290.93
|
| Rate for Payer: One Health Plan of WY PPO |
$454.72
|
| Rate for Payer: PacificSource Commercial |
$417.60
|
| Rate for Payer: PHCS PPO |
$454.72
|
| Rate for Payer: Three Rivers PPO |
$348.00
|
| Rate for Payer: TriWest Veterans Administration |
$306.24
|
| Rate for Payer: United Healthcare Commercial |
$403.68
|
| Rate for Payer: United Healthcare Medicare |
$306.24
|
| Rate for Payer: WINHealth Partners Commercial |
$440.80
|
| Rate for Payer: Wise Provider Network Commercial |
$440.80
|
|
|
HC CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
5102450501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$255.66 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$454.72
|
| Rate for Payer: Aetna of WY Medicare |
$306.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$445.44
|
| Rate for Payer: Altius Commercial |
$445.44
|
| Rate for Payer: Beech Street Commercial |
$454.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$380.94
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$450.08
|
| Rate for Payer: Cigna of WY Commercial |
$454.72
|
| Rate for Payer: Entrust Commercial |
$440.80
|
| Rate for Payer: First Choice Health Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.12
|
| Rate for Payer: HealthUtah PPO |
$464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$450.08
|
| Rate for Payer: Multiplan Medicare/VA |
$255.66
|
| Rate for Payer: One Health Plan of WY PPO |
$454.72
|
| Rate for Payer: PacificSource Commercial |
$417.60
|
| Rate for Payer: PHCS PPO |
$454.72
|
| Rate for Payer: Three Rivers PPO |
$348.00
|
| Rate for Payer: TriWest Veterans Administration |
$269.12
|
| Rate for Payer: United Healthcare Commercial |
$403.68
|
| Rate for Payer: United Healthcare Medicare |
$269.12
|
| Rate for Payer: WINHealth Partners Commercial |
$454.72
|
| Rate for Payer: Wise Provider Network Commercial |
$440.80
|
|
|
HC CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
5102776201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$438.06
|
| Rate for Payer: Aetna of WY Medicare |
$295.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$429.12
|
| Rate for Payer: Altius Commercial |
$429.12
|
| Rate for Payer: Beech Street Commercial |
$438.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$366.99
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.59
|
| Rate for Payer: Cigna of WY Commercial |
$438.06
|
| Rate for Payer: Entrust Commercial |
$424.65
|
| Rate for Payer: First Choice Health Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.26
|
| Rate for Payer: HealthUtah PPO |
$447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.59
|
| Rate for Payer: Multiplan Medicare/VA |
$246.30
|
| Rate for Payer: One Health Plan of WY PPO |
$438.06
|
| Rate for Payer: PacificSource Commercial |
$402.30
|
| Rate for Payer: PHCS PPO |
$438.06
|
| Rate for Payer: Three Rivers PPO |
$335.25
|
| Rate for Payer: TriWest Veterans Administration |
$259.26
|
| Rate for Payer: United Healthcare Commercial |
$388.89
|
| Rate for Payer: United Healthcare Medicare |
$259.26
|
| Rate for Payer: WINHealth Partners Commercial |
$438.06
|
| Rate for Payer: Wise Provider Network Commercial |
$424.65
|
|
|
HC CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
5102776201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$280.27 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$438.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$429.12
|
| Rate for Payer: Altius Commercial |
$429.12
|
| Rate for Payer: Beech Street Commercial |
$438.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$366.99
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.59
|
| Rate for Payer: Cigna of WY Commercial |
$438.06
|
| Rate for Payer: Entrust Commercial |
$424.65
|
| Rate for Payer: First Choice Health Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.02
|
| Rate for Payer: HealthUtah PPO |
$447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.59
|
| Rate for Payer: Multiplan Medicare/VA |
$280.27
|
| Rate for Payer: One Health Plan of WY PPO |
$438.06
|
| Rate for Payer: PacificSource Commercial |
$402.30
|
| Rate for Payer: PHCS PPO |
$438.06
|
| Rate for Payer: Three Rivers PPO |
$335.25
|
| Rate for Payer: TriWest Veterans Administration |
$295.02
|
| Rate for Payer: United Healthcare Commercial |
$388.89
|
| Rate for Payer: United Healthcare Medicare |
$295.02
|
| Rate for Payer: WINHealth Partners Commercial |
$424.65
|
| Rate for Payer: Wise Provider Network Commercial |
$424.65
|
|
|
HC CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
5102660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.98 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.88
|
| Rate for Payer: Altius Commercial |
$290.88
|
| Rate for Payer: Beech Street Commercial |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.76
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.91
|
| Rate for Payer: Cigna of WY Commercial |
$296.94
|
| Rate for Payer: Entrust Commercial |
$287.85
|
| Rate for Payer: First Choice Health Commercial |
$287.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.98
|
| Rate for Payer: HealthUtah PPO |
$303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.91
|
| Rate for Payer: Multiplan Medicare/VA |
$189.98
|
| Rate for Payer: One Health Plan of WY PPO |
$296.94
|
| Rate for Payer: PacificSource Commercial |
$272.70
|
| Rate for Payer: PHCS PPO |
$296.94
|
| Rate for Payer: Three Rivers PPO |
$227.25
|
| Rate for Payer: TriWest Veterans Administration |
$199.98
|
| Rate for Payer: United Healthcare Commercial |
$263.61
|
| Rate for Payer: United Healthcare Medicare |
$199.98
|
| Rate for Payer: WINHealth Partners Commercial |
$287.85
|
| Rate for Payer: Wise Provider Network Commercial |
$287.85
|
|
|
HC CLTX METACARPAL FX W/MANIPULATION EACH BONE
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
5102660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.95 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.94
|
| Rate for Payer: Aetna of WY Medicare |
$199.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$290.88
|
| Rate for Payer: Altius Commercial |
$290.88
|
| Rate for Payer: Beech Street Commercial |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$248.76
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.91
|
| Rate for Payer: Cigna of WY Commercial |
$296.94
|
| Rate for Payer: Entrust Commercial |
$287.85
|
| Rate for Payer: First Choice Health Commercial |
$287.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$287.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.74
|
| Rate for Payer: HealthUtah PPO |
$303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.91
|
| Rate for Payer: Multiplan Medicare/VA |
$166.95
|
| Rate for Payer: One Health Plan of WY PPO |
$296.94
|
| Rate for Payer: PacificSource Commercial |
$272.70
|
| Rate for Payer: PHCS PPO |
$296.94
|
| Rate for Payer: Three Rivers PPO |
$227.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.74
|
| Rate for Payer: United Healthcare Commercial |
$263.61
|
| Rate for Payer: United Healthcare Medicare |
$175.74
|
| Rate for Payer: WINHealth Partners Commercial |
$296.94
|
| Rate for Payer: Wise Provider Network Commercial |
$287.85
|
|
|
HC CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
5102670001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.44 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$239.12
|
| Rate for Payer: Aetna of WY Medicare |
$161.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$234.24
|
| Rate for Payer: Altius Commercial |
$234.24
|
| Rate for Payer: Beech Street Commercial |
$239.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$200.32
|
| Rate for Payer: Cash Price |
$170.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$236.68
|
| Rate for Payer: Cigna of WY Commercial |
$239.12
|
| Rate for Payer: Entrust Commercial |
$231.80
|
| Rate for Payer: First Choice Health Commercial |
$231.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$231.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.52
|
| Rate for Payer: HealthUtah PPO |
$244.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$236.68
|
| Rate for Payer: Multiplan Medicare/VA |
$134.44
|
| Rate for Payer: One Health Plan of WY PPO |
$239.12
|
| Rate for Payer: PacificSource Commercial |
$219.60
|
| Rate for Payer: PHCS PPO |
$239.12
|
| Rate for Payer: Three Rivers PPO |
$183.00
|
| Rate for Payer: TriWest Veterans Administration |
$141.52
|
| Rate for Payer: United Healthcare Commercial |
$212.28
|
| Rate for Payer: United Healthcare Medicare |
$141.52
|
| Rate for Payer: WINHealth Partners Commercial |
$239.12
|
| Rate for Payer: Wise Provider Network Commercial |
$231.80
|
|
|
HC CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
5102670001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.99 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$239.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$234.24
|
| Rate for Payer: Altius Commercial |
$234.24
|
| Rate for Payer: Beech Street Commercial |
$239.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$200.32
|
| Rate for Payer: Cash Price |
$170.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$236.68
|
| Rate for Payer: Cigna of WY Commercial |
$239.12
|
| Rate for Payer: Entrust Commercial |
$231.80
|
| Rate for Payer: First Choice Health Commercial |
$231.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$231.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.04
|
| Rate for Payer: HealthUtah PPO |
$244.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$236.68
|
| Rate for Payer: Multiplan Medicare/VA |
$152.99
|
| Rate for Payer: One Health Plan of WY PPO |
$239.12
|
| Rate for Payer: PacificSource Commercial |
$219.60
|
| Rate for Payer: PHCS PPO |
$239.12
|
| Rate for Payer: Three Rivers PPO |
$183.00
|
| Rate for Payer: TriWest Veterans Administration |
$161.04
|
| Rate for Payer: United Healthcare Commercial |
$212.28
|
| Rate for Payer: United Healthcare Medicare |
$161.04
|
| Rate for Payer: WINHealth Partners Commercial |
$231.80
|
| Rate for Payer: Wise Provider Network Commercial |
$231.80
|
|
