|
HC APPLICATION OF SHORT ARM SPLIN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
5102912601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Aetna of WY Medicare |
$199.32
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$292.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.14
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$163.53
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$172.14
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
| Rate for Payer: United Healthcare Medicare |
$172.14
|
| Rate for Payer: WINHealth Partners Commercial |
$295.96
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC APPLICATION OF SHORT ARM SPLIN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
5102912601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.01 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$295.96
|
| Rate for Payer: Aetna of WY Medicare |
$193.28
|
| Rate for Payer: Altius Commercial |
$289.92
|
| Rate for Payer: Beech Street Commercial |
$295.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$292.94
|
| Rate for Payer: Cash Price |
$211.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$292.94
|
| Rate for Payer: Cigna of WY Commercial |
$295.96
|
| Rate for Payer: Entrust Commercial |
$286.90
|
| Rate for Payer: First Choice Health Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.22
|
| Rate for Payer: HealthUtah PPO |
$302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$292.94
|
| Rate for Payer: Multiplan Medicare/VA |
$175.01
|
| Rate for Payer: One Health Plan of WY PPO |
$295.96
|
| Rate for Payer: PacificSource Commercial |
$271.80
|
| Rate for Payer: PHCS PPO |
$295.96
|
| Rate for Payer: Three Rivers PPO |
$226.50
|
| Rate for Payer: TriWest Veterans Administration |
$184.22
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
| Rate for Payer: United Healthcare Medicare |
$184.22
|
| Rate for Payer: WINHealth Partners Commercial |
$286.90
|
| Rate for Payer: Wise Provider Network Commercial |
$286.90
|
|
|
HC APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$30.36
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.22
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$24.91
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.22
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$26.22
|
| Rate for Payer: WINHealth Partners Commercial |
$45.08
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
5102940501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$29.44
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.62
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.06
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$26.66
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$28.06
|
| Rate for Payer: United Healthcare Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare |
$28.06
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$56.76
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.02
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$46.57
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$49.02
|
| Rate for Payer: United Healthcare Commercial |
$82.13
|
| Rate for Payer: United Healthcare Medicare |
$49.02
|
| Rate for Payer: WINHealth Partners Commercial |
$84.28
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
5102958101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$55.04
|
| Rate for Payer: Altius Commercial |
$82.56
|
| Rate for Payer: Beech Street Commercial |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: Entrust Commercial |
$81.70
|
| Rate for Payer: First Choice Health Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.46
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$49.84
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$84.28
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.46
|
| Rate for Payer: United Healthcare Commercial |
$82.13
|
| Rate for Payer: United Healthcare Medicare |
$52.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.70
|
| Rate for Payer: Wise Provider Network Commercial |
$81.70
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$335.16
|
| Rate for Payer: Aetna of WY Medicare |
$218.88
|
| Rate for Payer: Altius Commercial |
$328.32
|
| Rate for Payer: Beech Street Commercial |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$331.74
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$331.74
|
| Rate for Payer: Cigna of WY Commercial |
$335.16
|
| Rate for Payer: Entrust Commercial |
$324.90
|
| Rate for Payer: First Choice Health Commercial |
$324.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$324.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.62
|
| Rate for Payer: HealthUtah PPO |
$342.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$331.74
|
| Rate for Payer: Multiplan Medicare/VA |
$198.19
|
| Rate for Payer: One Health Plan of WY PPO |
$335.16
|
| Rate for Payer: PacificSource Commercial |
$307.80
|
| Rate for Payer: PHCS PPO |
$335.16
|
| Rate for Payer: Three Rivers PPO |
$256.50
|
| Rate for Payer: TriWest Veterans Administration |
$208.62
|
| Rate for Payer: United Healthcare Commercial |
$326.61
|
| Rate for Payer: United Healthcare Medicare |
$208.62
|
| Rate for Payer: WINHealth Partners Commercial |
$324.90
|
| Rate for Payer: Wise Provider Network Commercial |
$324.90
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$185.19 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$335.16
|
| Rate for Payer: Aetna of WY Medicare |
$225.72
|
| Rate for Payer: Altius Commercial |
$328.32
|
| Rate for Payer: Beech Street Commercial |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$331.74
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$331.74
|
| Rate for Payer: Cigna of WY Commercial |
$335.16
|
| Rate for Payer: Entrust Commercial |
$324.90
|
| Rate for Payer: First Choice Health Commercial |
$324.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$324.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.94
|
| Rate for Payer: HealthUtah PPO |
$342.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$331.74
|
| Rate for Payer: Multiplan Medicare/VA |
$185.19
|
| Rate for Payer: One Health Plan of WY PPO |
$335.16
|
| Rate for Payer: PacificSource Commercial |
$307.80
|
| Rate for Payer: PHCS PPO |
$335.16
|
| Rate for Payer: Three Rivers PPO |
$256.50
|
| Rate for Payer: TriWest Veterans Administration |
$194.94
|
| Rate for Payer: United Healthcare Commercial |
$326.61
|
| Rate for Payer: United Healthcare Medicare |
$194.94
|
| Rate for Payer: WINHealth Partners Commercial |
$335.16
|
| Rate for Payer: Wise Provider Network Commercial |
$324.90
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
5102913001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$15.18
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.11
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.45
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.11
|
| Rate for Payer: United Healthcare Commercial |
$21.96
|
| Rate for Payer: United Healthcare Medicare |
$13.11
|
| Rate for Payer: WINHealth Partners Commercial |
$22.54
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
5102913001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$14.72
|
| Rate for Payer: Altius Commercial |
$22.08
|
| Rate for Payer: Beech Street Commercial |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.31
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: Entrust Commercial |
$21.85
|
| Rate for Payer: First Choice Health Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.03
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$13.33
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$22.54
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$14.03
|
| Rate for Payer: United Healthcare Commercial |
$21.96
|
| Rate for Payer: United Healthcare Medicare |
$14.03
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
| Rate for Payer: Wise Provider Network Commercial |
$21.85
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.36
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$25.99
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.36
|
| Rate for Payer: United Healthcare Commercial |
$45.84
|
| Rate for Payer: United Healthcare Medicare |
$27.36
|
| Rate for Payer: WINHealth Partners Commercial |
$47.04
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
5102907501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$30.72
|
| Rate for Payer: Altius Commercial |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: Entrust Commercial |
$45.60
|
| Rate for Payer: First Choice Health Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.28
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$27.82
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$47.04
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$29.28
|
| Rate for Payer: United Healthcare Commercial |
$45.84
|
| Rate for Payer: United Healthcare Medicare |
$29.28
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
| Rate for Payer: Wise Provider Network Commercial |
$45.60
|
|
|
HC APPLY FOREARM SPLINT,DYNAMIC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
7002912601
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM SPLINT,DYNAMIC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
7002912601
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.20
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.30
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$17.38
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$18.30
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$18.30
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$70.40
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.10
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.24
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$17.10
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
7612906501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.34 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$83.20
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.30
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$75.34
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.30
|
| Rate for Payer: United Healthcare Commercial |
$124.15
|
| Rate for Payer: United Healthcare Medicare |
$79.30
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.48 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.74
|
| Rate for Payer: Aetna of WY Medicare |
$72.32
|
| 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 |
$109.61
|
| 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 |
$68.93
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$65.48
|
| 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 |
$68.93
|
| Rate for Payer: United Healthcare Commercial |
$107.92
|
| Rate for Payer: United Healthcare Medicare |
$68.93
|
| Rate for Payer: WINHealth Partners Commercial |
$107.35
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.19 |
| 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 Commercial |
$108.48
|
| Rate for Payer: Beech Street Commercial |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.61
|
| 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 |
$64.41
|
| Rate for Payer: HealthUtah PPO |
$113.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.61
|
| Rate for Payer: Multiplan Medicare/VA |
$61.19
|
| 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 |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$107.92
|
| Rate for Payer: United Healthcare Medicare |
$64.41
|
| Rate for Payer: WINHealth Partners Commercial |
$110.74
|
| Rate for Payer: Wise Provider Network Commercial |
$107.35
|
|
