|
HC CLTX METAR FX W/MANJ
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
5102847501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$154.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.64
|
| Rate for Payer: Altius Commercial |
$224.64
|
| Rate for Payer: Beech Street Commercial |
$229.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.11
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: Entrust Commercial |
$222.30
|
| Rate for Payer: First Choice Health Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.72
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$128.93
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$229.32
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.72
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$135.72
|
| Rate for Payer: WINHealth Partners Commercial |
$229.32
|
| Rate for Payer: Wise Provider Network Commercial |
$222.30
|
|
|
HC CLTX METAR FX W/MANJ
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
5102847501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.72 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.64
|
| Rate for Payer: Altius Commercial |
$224.64
|
| Rate for Payer: Beech Street Commercial |
$229.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.11
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: Entrust Commercial |
$222.30
|
| Rate for Payer: First Choice Health Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.44
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$146.72
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$229.32
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$154.44
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$154.44
|
| Rate for Payer: WINHealth Partners Commercial |
$222.30
|
| Rate for Payer: Wise Provider Network Commercial |
$222.30
|
|
|
HC CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5102863001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.90
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$72.10
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$75.90
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$75.90
|
| Rate for Payer: WINHealth Partners Commercial |
$109.25
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
5102863001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$75.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.40
|
| Rate for Payer: Altius Commercial |
$110.40
|
| Rate for Payer: Beech Street Commercial |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: Entrust Commercial |
$109.25
|
| Rate for Payer: First Choice Health Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.70
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$63.36
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$112.70
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$66.70
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$66.70
|
| Rate for Payer: WINHealth Partners Commercial |
$112.70
|
| Rate for Payer: Wise Provider Network Commercial |
$109.25
|
|
|
HC CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
5102672501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.36
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$154.24
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$162.36
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$162.36
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
5102672501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.68
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$135.55
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.68
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$142.68
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC CLTX POST HIP ARTHRP DISLC REQ ANES
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
5102726601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.83 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.96
|
| Rate for Payer: Altius Commercial |
$576.96
|
| Rate for Payer: Beech Street Commercial |
$588.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$493.42
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.97
|
| Rate for Payer: Cigna of WY Commercial |
$588.98
|
| Rate for Payer: Entrust Commercial |
$570.95
|
| Rate for Payer: First Choice Health Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.66
|
| Rate for Payer: HealthUtah PPO |
$601.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.97
|
| Rate for Payer: Multiplan Medicare/VA |
$376.83
|
| Rate for Payer: One Health Plan of WY PPO |
$588.98
|
| Rate for Payer: PacificSource Commercial |
$540.90
|
| Rate for Payer: PHCS PPO |
$588.98
|
| Rate for Payer: Three Rivers PPO |
$450.75
|
| Rate for Payer: TriWest Veterans Administration |
$396.66
|
| Rate for Payer: United Healthcare Commercial |
$522.87
|
| Rate for Payer: United Healthcare Medicare |
$396.66
|
| Rate for Payer: WINHealth Partners Commercial |
$570.95
|
| Rate for Payer: Wise Provider Network Commercial |
$570.95
|
|
|
HC CLTX POST HIP ARTHRP DISLC REQ ANES
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
5102726601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.15 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.98
|
| Rate for Payer: Aetna of WY Medicare |
$396.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.96
|
| Rate for Payer: Altius Commercial |
$576.96
|
| Rate for Payer: Beech Street Commercial |
$588.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$493.42
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.97
|
| Rate for Payer: Cigna of WY Commercial |
$588.98
|
| Rate for Payer: Entrust Commercial |
$570.95
|
| Rate for Payer: First Choice Health Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.58
|
| Rate for Payer: HealthUtah PPO |
$601.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.97
|
| Rate for Payer: Multiplan Medicare/VA |
$331.15
|
| Rate for Payer: One Health Plan of WY PPO |
$588.98
|
| Rate for Payer: PacificSource Commercial |
$540.90
|
| Rate for Payer: PHCS PPO |
$588.98
|
| Rate for Payer: Three Rivers PPO |
$450.75
|
| Rate for Payer: TriWest Veterans Administration |
$348.58
|
| Rate for Payer: United Healthcare Commercial |
$522.87
|
| Rate for Payer: United Healthcare Medicare |
$348.58
|
| Rate for Payer: WINHealth Partners Commercial |
$588.98
|
| Rate for Payer: Wise Provider Network Commercial |
$570.95
|
|
|
HC CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
5102726501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$261.46 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$408.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$400.32
|
| Rate for Payer: Altius Commercial |
$400.32
|
| Rate for Payer: Beech Street Commercial |
$408.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$342.36
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$404.49
|
| Rate for Payer: Cigna of WY Commercial |
$408.66
|
| Rate for Payer: Entrust Commercial |
$396.15
|
| Rate for Payer: First Choice Health Commercial |
$396.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$396.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.22
|
| Rate for Payer: HealthUtah PPO |
$417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$404.49
|
| Rate for Payer: Multiplan Medicare/VA |
$261.46
|
| Rate for Payer: One Health Plan of WY PPO |
$408.66
|
| Rate for Payer: PacificSource Commercial |
$375.30
|
| Rate for Payer: PHCS PPO |
$408.66
|
| Rate for Payer: Three Rivers PPO |
$312.75
|
| Rate for Payer: TriWest Veterans Administration |
$275.22
|
| Rate for Payer: United Healthcare Commercial |
$362.79
|
| Rate for Payer: United Healthcare Medicare |
$275.22
|
| Rate for Payer: WINHealth Partners Commercial |
$396.15
|
| Rate for Payer: Wise Provider Network Commercial |
$396.15
|
|
|
HC CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
5102726501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.77 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$408.66
|
| Rate for Payer: Aetna of WY Medicare |
$275.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$400.32
|
| Rate for Payer: Altius Commercial |
$400.32
|
| Rate for Payer: Beech Street Commercial |
$408.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$342.36
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$404.49
|
| Rate for Payer: Cigna of WY Commercial |
$408.66
|
| Rate for Payer: Entrust Commercial |
$396.15
|
| Rate for Payer: First Choice Health Commercial |
$396.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$396.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$241.86
|
| Rate for Payer: HealthUtah PPO |
$417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$404.49
|
| Rate for Payer: Multiplan Medicare/VA |
$229.77
|
| Rate for Payer: One Health Plan of WY PPO |
$408.66
|
| Rate for Payer: PacificSource Commercial |
$375.30
|
| Rate for Payer: PHCS PPO |
$408.66
|
| Rate for Payer: Three Rivers PPO |
$312.75
|
| Rate for Payer: TriWest Veterans Administration |
$241.86
|
| Rate for Payer: United Healthcare Commercial |
$362.79
|
| Rate for Payer: United Healthcare Medicare |
$241.86
|
| Rate for Payer: WINHealth Partners Commercial |
$408.66
|
| Rate for Payer: Wise Provider Network Commercial |
$396.15
|
|
|
HC CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
5102360501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.37 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$418.56
|
| Rate for Payer: Altius Commercial |
$418.56
|
| Rate for Payer: Beech Street Commercial |
$427.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.96
|
| Rate for Payer: Cash Price |
$305.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$422.92
|
| Rate for Payer: Cigna of WY Commercial |
$427.28
|
| Rate for Payer: Entrust Commercial |
$414.20
|
| Rate for Payer: First Choice Health Commercial |
$414.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.76
|
| Rate for Payer: HealthUtah PPO |
$436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.92
|
| Rate for Payer: Multiplan Medicare/VA |
$273.37
|
| Rate for Payer: One Health Plan of WY PPO |
$427.28
|
| Rate for Payer: PacificSource Commercial |
$392.40
|
| Rate for Payer: PHCS PPO |
$427.28
|
| Rate for Payer: Three Rivers PPO |
$327.00
|
| Rate for Payer: TriWest Veterans Administration |
$287.76
|
| Rate for Payer: United Healthcare Commercial |
$379.32
|
| Rate for Payer: United Healthcare Medicare |
$287.76
|
| Rate for Payer: WINHealth Partners Commercial |
$414.20
|
| Rate for Payer: Wise Provider Network Commercial |
$414.20
|
|
|
HC CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
5102360501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.28
|
| Rate for Payer: Aetna of WY Medicare |
$287.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$418.56
|
| Rate for Payer: Altius Commercial |
$418.56
|
| Rate for Payer: Beech Street Commercial |
$427.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.96
|
| Rate for Payer: Cash Price |
$305.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$422.92
|
| Rate for Payer: Cigna of WY Commercial |
$427.28
|
| Rate for Payer: Entrust Commercial |
$414.20
|
| Rate for Payer: First Choice Health Commercial |
$414.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.88
|
| Rate for Payer: HealthUtah PPO |
$436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.92
|
| Rate for Payer: Multiplan Medicare/VA |
$240.24
|
| Rate for Payer: One Health Plan of WY PPO |
$427.28
|
| Rate for Payer: PacificSource Commercial |
$392.40
|
| Rate for Payer: PHCS PPO |
$427.28
|
| Rate for Payer: Three Rivers PPO |
$327.00
|
| Rate for Payer: TriWest Veterans Administration |
$252.88
|
| Rate for Payer: United Healthcare Commercial |
$379.32
|
| Rate for Payer: United Healthcare Medicare |
$252.88
|
| Rate for Payer: WINHealth Partners Commercial |
$427.28
|
| Rate for Payer: Wise Provider Network Commercial |
$414.20
|
|
|
HC CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
5102464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$53.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.98
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$44.63
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$46.98
|
| Rate for Payer: WINHealth Partners Commercial |
$79.38
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
5102464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.46
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$50.79
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.46
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$53.46
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
5102552001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.13 |
| Max. Negotiated Rate |
$581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$569.38
|
| Rate for Payer: Aetna of WY Medicare |
$383.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$557.76
|
| Rate for Payer: Altius Commercial |
$557.76
|
| Rate for Payer: Beech Street Commercial |
$569.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$477.00
|
| Rate for Payer: Cash Price |
$406.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$563.57
|
| Rate for Payer: Cigna of WY Commercial |
$569.38
|
| Rate for Payer: Entrust Commercial |
$551.95
|
| Rate for Payer: First Choice Health Commercial |
$551.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.98
|
| Rate for Payer: HealthUtah PPO |
$581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$563.57
|
| Rate for Payer: Multiplan Medicare/VA |
$320.13
|
| Rate for Payer: One Health Plan of WY PPO |
$569.38
|
| Rate for Payer: PacificSource Commercial |
$522.90
|
| Rate for Payer: PHCS PPO |
$569.38
|
| Rate for Payer: Three Rivers PPO |
$435.75
|
| Rate for Payer: TriWest Veterans Administration |
$336.98
|
| Rate for Payer: United Healthcare Commercial |
$505.47
|
| Rate for Payer: United Healthcare Medicare |
$336.98
|
| Rate for Payer: WINHealth Partners Commercial |
$569.38
|
| Rate for Payer: Wise Provider Network Commercial |
$551.95
|
|
|
HC CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
5102552001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$364.29 |
| Max. Negotiated Rate |
$581.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$569.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$557.76
|
| Rate for Payer: Altius Commercial |
$557.76
|
| Rate for Payer: Beech Street Commercial |
$569.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$477.00
|
| Rate for Payer: Cash Price |
$406.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$563.57
|
| Rate for Payer: Cigna of WY Commercial |
$569.38
|
| Rate for Payer: Entrust Commercial |
$551.95
|
| Rate for Payer: First Choice Health Commercial |
$551.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$383.46
|
| Rate for Payer: HealthUtah PPO |
$581.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$563.57
|
| Rate for Payer: Multiplan Medicare/VA |
$364.29
|
| Rate for Payer: One Health Plan of WY PPO |
$569.38
|
| Rate for Payer: PacificSource Commercial |
$522.90
|
| Rate for Payer: PHCS PPO |
$569.38
|
| Rate for Payer: Three Rivers PPO |
$435.75
|
| Rate for Payer: TriWest Veterans Administration |
$383.46
|
| Rate for Payer: United Healthcare Commercial |
$505.47
|
| Rate for Payer: United Healthcare Medicare |
$383.46
|
| Rate for Payer: WINHealth Partners Commercial |
$551.95
|
| Rate for Payer: Wise Provider Network Commercial |
$551.95
|
|
|
HC CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
5102357501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.54 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$259.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.94
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$216.54
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$227.94
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$227.94
|
| Rate for Payer: WINHealth Partners Commercial |
$385.14
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
5102357501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.41 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$377.28
|
| Rate for Payer: Altius Commercial |
$377.28
|
| Rate for Payer: Beech Street Commercial |
$385.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$322.65
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: Entrust Commercial |
$373.35
|
| Rate for Payer: First Choice Health Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.38
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$246.41
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$385.14
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$259.38
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$259.38
|
| Rate for Payer: WINHealth Partners Commercial |
$373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$373.35
|
|
|
HC CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
5102366501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$247.66 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.70
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$247.66
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$260.70
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
| Rate for Payer: WINHealth Partners Commercial |
$375.25
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
5102366501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$260.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.10
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$217.64
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.10
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$387.10
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MNPJ
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
5102367501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MNPJ
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
5102367501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
5102453501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.10
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$366.80
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$386.10
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$386.10
|
| Rate for Payer: WINHealth Partners Commercial |
$555.75
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
5102453501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$386.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.30
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$322.34
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$339.30
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$339.30
|
| Rate for Payer: WINHealth Partners Commercial |
$573.30
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
5102453001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$349.86
|
| Rate for Payer: Aetna of WY Medicare |
$235.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$342.72
|
| Rate for Payer: Altius Commercial |
$342.72
|
| Rate for Payer: Beech Street Commercial |
$349.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.10
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$346.29
|
| Rate for Payer: Cigna of WY Commercial |
$349.86
|
| Rate for Payer: Entrust Commercial |
$339.15
|
| Rate for Payer: First Choice Health Commercial |
$339.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$339.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.06
|
| Rate for Payer: HealthUtah PPO |
$357.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$346.29
|
| Rate for Payer: Multiplan Medicare/VA |
$196.71
|
| Rate for Payer: One Health Plan of WY PPO |
$349.86
|
| Rate for Payer: PacificSource Commercial |
$321.30
|
| Rate for Payer: PHCS PPO |
$349.86
|
| Rate for Payer: Three Rivers PPO |
$267.75
|
| Rate for Payer: TriWest Veterans Administration |
$207.06
|
| Rate for Payer: United Healthcare Commercial |
$310.59
|
| Rate for Payer: United Healthcare Medicare |
$207.06
|
| Rate for Payer: WINHealth Partners Commercial |
$349.86
|
| Rate for Payer: Wise Provider Network Commercial |
$339.15
|
|
