|
HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
3068748601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$142.08
|
| Rate for Payer: Altius Commercial |
$213.12
|
| Rate for Payer: Beech Street Commercial |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$215.34
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: Entrust Commercial |
$210.90
|
| Rate for Payer: First Choice Health Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.42
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$128.65
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$217.56
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.42
|
| Rate for Payer: United Healthcare Commercial |
$212.01
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WINHealth Partners Commercial |
$210.90
|
| Rate for Payer: Wise Provider Network Commercial |
$210.90
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$91.52
|
| Rate for Payer: Altius Commercial |
$137.28
|
| Rate for Payer: Beech Street Commercial |
$140.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.71
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: Entrust Commercial |
$135.85
|
| Rate for Payer: First Choice Health Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.23
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$82.87
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$140.14
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$87.23
|
| Rate for Payer: United Healthcare Commercial |
$136.56
|
| Rate for Payer: United Healthcare Medicare |
$87.23
|
| Rate for Payer: WINHealth Partners Commercial |
$135.85
|
| Rate for Payer: Wise Provider Network Commercial |
$135.85
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA DNA PCR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.43 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$94.38
|
| Rate for Payer: Altius Commercial |
$137.28
|
| Rate for Payer: Beech Street Commercial |
$140.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.71
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: Entrust Commercial |
$135.85
|
| Rate for Payer: First Choice Health Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.51
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$77.43
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$140.14
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$81.51
|
| Rate for Payer: United Healthcare Commercial |
$136.56
|
| Rate for Payer: United Healthcare Medicare |
$81.51
|
| Rate for Payer: WINHealth Partners Commercial |
$140.14
|
| Rate for Payer: Wise Provider Network Commercial |
$135.85
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.67 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$983.92
|
| Rate for Payer: Aetna of WY Medicare |
$662.64
|
| Rate for Payer: Altius Commercial |
$963.84
|
| Rate for Payer: Beech Street Commercial |
$983.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$973.88
|
| Rate for Payer: Cash Price |
$702.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$973.88
|
| Rate for Payer: Cigna of WY Commercial |
$983.92
|
| Rate for Payer: Entrust Commercial |
$953.80
|
| Rate for Payer: First Choice Health Commercial |
$953.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$953.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$572.28
|
| Rate for Payer: HealthUtah PPO |
$1,004.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$973.88
|
| Rate for Payer: Multiplan Medicare/VA |
$543.67
|
| Rate for Payer: One Health Plan of WY PPO |
$983.92
|
| Rate for Payer: PacificSource Commercial |
$903.60
|
| Rate for Payer: PHCS PPO |
$983.92
|
| Rate for Payer: Three Rivers PPO |
$753.00
|
| Rate for Payer: TriWest Veterans Administration |
$572.28
|
| Rate for Payer: United Healthcare Commercial |
$958.82
|
| Rate for Payer: United Healthcare Medicare |
$572.28
|
| Rate for Payer: WINHealth Partners Commercial |
$983.92
|
| Rate for Payer: Wise Provider Network Commercial |
$953.80
|
|
|
HC CINE/VID X-RAY THROAT/ESOPH - FL ESOPH BARIUM SWLW W/ VIDEO & SPEECH
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
3207423001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$581.82 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$983.92
|
| Rate for Payer: Aetna of WY Medicare |
$642.56
|
| Rate for Payer: Altius Commercial |
$963.84
|
| Rate for Payer: Beech Street Commercial |
$983.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$973.88
|
| Rate for Payer: Cash Price |
$702.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$973.88
|
| Rate for Payer: Cigna of WY Commercial |
$983.92
|
| Rate for Payer: Entrust Commercial |
$953.80
|
| Rate for Payer: First Choice Health Commercial |
$953.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$953.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$612.44
|
| Rate for Payer: HealthUtah PPO |
$1,004.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$973.88
|
| Rate for Payer: Multiplan Medicare/VA |
$581.82
|
| Rate for Payer: One Health Plan of WY PPO |
$983.92
|
| Rate for Payer: PacificSource Commercial |
$903.60
|
| Rate for Payer: PHCS PPO |
$983.92
|
| Rate for Payer: Three Rivers PPO |
$753.00
|
| Rate for Payer: TriWest Veterans Administration |
$612.44
|
| Rate for Payer: United Healthcare Commercial |
$958.82
|
| Rate for Payer: United Healthcare Medicare |
$612.44
|
| Rate for Payer: WINHealth Partners Commercial |
$953.80
|
| Rate for Payer: Wise Provider Network Commercial |
$953.80
|
|
|
HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.11 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$73.26
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.27
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$60.11
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$63.27
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WINHealth Partners Commercial |
$108.78
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$108.78
|
| Rate for Payer: Aetna of WY Medicare |
$71.04
|
| Rate for Payer: Altius Commercial |
$106.56
|
| Rate for Payer: Beech Street Commercial |
$108.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.67
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$107.67
|
| Rate for Payer: Cigna of WY Commercial |
$108.78
|
| Rate for Payer: Entrust Commercial |
$105.45
|
| Rate for Payer: First Choice Health Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.71
|
| Rate for Payer: HealthUtah PPO |
$111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$107.67
|
| Rate for Payer: Multiplan Medicare/VA |
$64.32
|
| Rate for Payer: One Health Plan of WY PPO |
$108.78
|
| Rate for Payer: PacificSource Commercial |
$99.90
|
| Rate for Payer: PHCS PPO |
$108.78
|
| Rate for Payer: Three Rivers PPO |
$83.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.71
|
| Rate for Payer: United Healthcare Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare |
$67.71
|
| Rate for Payer: WINHealth Partners Commercial |
$105.45
|
| Rate for Payer: Wise Provider Network Commercial |
$105.45
|
|
|
HC CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
5102722201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$706.58
|
| Rate for Payer: Aetna of WY Medicare |
$461.44
|
| Rate for Payer: Altius Commercial |
$692.16
|
| Rate for Payer: Beech Street Commercial |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$699.37
|
| Rate for Payer: Cash Price |
$504.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$699.37
|
| Rate for Payer: Cigna of WY Commercial |
$706.58
|
| Rate for Payer: Entrust Commercial |
$684.95
|
| Rate for Payer: First Choice Health Commercial |
$684.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.81
|
| Rate for Payer: HealthUtah PPO |
$721.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$699.37
|
| Rate for Payer: Multiplan Medicare/VA |
$417.82
|
| Rate for Payer: One Health Plan of WY PPO |
$706.58
|
| Rate for Payer: PacificSource Commercial |
$648.90
|
| Rate for Payer: PHCS PPO |
$706.58
|
| Rate for Payer: Three Rivers PPO |
$540.75
|
| Rate for Payer: TriWest Veterans Administration |
$439.81
|
| Rate for Payer: United Healthcare Commercial |
$688.56
|
| Rate for Payer: United Healthcare Medicare |
$439.81
|
| Rate for Payer: WINHealth Partners Commercial |
$684.95
|
| Rate for Payer: Wise Provider Network Commercial |
$684.95
|
|
|
HC CLOSED TX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
5102722201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$390.42 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$706.58
|
| Rate for Payer: Aetna of WY Medicare |
$475.86
|
| Rate for Payer: Altius Commercial |
$692.16
|
| Rate for Payer: Beech Street Commercial |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$699.37
|
| Rate for Payer: Cash Price |
$504.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$699.37
|
| Rate for Payer: Cigna of WY Commercial |
$706.58
|
| Rate for Payer: Entrust Commercial |
$684.95
|
| Rate for Payer: First Choice Health Commercial |
$684.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.97
|
| Rate for Payer: HealthUtah PPO |
$721.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$699.37
|
| Rate for Payer: Multiplan Medicare/VA |
$390.42
|
| Rate for Payer: One Health Plan of WY PPO |
$706.58
|
| Rate for Payer: PacificSource Commercial |
$648.90
|
| Rate for Payer: PHCS PPO |
$706.58
|
| Rate for Payer: Three Rivers PPO |
$540.75
|
| Rate for Payer: TriWest Veterans Administration |
$410.97
|
| Rate for Payer: United Healthcare Commercial |
$688.56
|
| Rate for Payer: United Healthcare Medicare |
$410.97
|
| Rate for Payer: WINHealth Partners Commercial |
$706.58
|
| Rate for Payer: Wise Provider Network Commercial |
$684.95
|
|
|
HC CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
7612784201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIX
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
7612784201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX ANKLE DISLOCATN
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CLOSED TX ANKLE DISLOCATN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CLOSED TX BIG TOE FX,MANIP
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
7612849501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX BIG TOE FX,MANIP
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
7612849501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
7612781001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$300.96
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.92
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$246.92
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$259.92
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$259.92
|
| Rate for Payer: WINHealth Partners Commercial |
$446.88
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
7612781001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.88
|
| Rate for Payer: Aetna of WY Medicare |
$291.84
|
| Rate for Payer: Altius Commercial |
$437.76
|
| Rate for Payer: Beech Street Commercial |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.32
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.32
|
| Rate for Payer: Cigna of WY Commercial |
$446.88
|
| Rate for Payer: Entrust Commercial |
$433.20
|
| Rate for Payer: First Choice Health Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.16
|
| Rate for Payer: HealthUtah PPO |
$456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.32
|
| Rate for Payer: Multiplan Medicare/VA |
$264.25
|
| Rate for Payer: One Health Plan of WY PPO |
$446.88
|
| Rate for Payer: PacificSource Commercial |
$410.40
|
| Rate for Payer: PHCS PPO |
$446.88
|
| Rate for Payer: Three Rivers PPO |
$342.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.16
|
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| Rate for Payer: United Healthcare Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
5102563001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$145.92
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.08
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$132.13
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$139.08
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$139.08
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
7612563001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
7612563001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX CARPAL BONE FX W/O MANIPULATION
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
5102563001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.16
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.96
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$123.46
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.96
|
| Rate for Payer: United Healthcare Commercial |
$217.74
|
| Rate for Payer: United Healthcare Medicare |
$129.96
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
7612562201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$181.12
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.63
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$164.00
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$172.63
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$172.63
|
| Rate for Payer: WINHealth Partners Commercial |
$268.85
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
7612562201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Aetna of WY Medicare |
$186.78
|
| Rate for Payer: Altius Commercial |
$271.68
|
| Rate for Payer: Beech Street Commercial |
$277.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: Entrust Commercial |
$268.85
|
| Rate for Payer: First Choice Health Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.31
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: Multiplan Medicare/VA |
$153.24
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$277.34
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: TriWest Veterans Administration |
$161.31
|
| Rate for Payer: United Healthcare Commercial |
$270.26
|
| Rate for Payer: United Healthcare Medicare |
$161.31
|
| Rate for Payer: WINHealth Partners Commercial |
$277.34
|
| Rate for Payer: Wise Provider Network Commercial |
$268.85
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$221.48
|
| Rate for Payer: Aetna of WY Medicare |
$144.64
|
| Rate for Payer: Altius Commercial |
$216.96
|
| Rate for Payer: Beech Street Commercial |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$219.22
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$219.22
|
| Rate for Payer: Cigna of WY Commercial |
$221.48
|
| Rate for Payer: Entrust Commercial |
$214.70
|
| Rate for Payer: First Choice Health Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$137.86
|
| Rate for Payer: HealthUtah PPO |
$226.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$219.22
|
| Rate for Payer: Multiplan Medicare/VA |
$130.97
|
| Rate for Payer: One Health Plan of WY PPO |
$221.48
|
| Rate for Payer: PacificSource Commercial |
$203.40
|
| Rate for Payer: PHCS PPO |
$221.48
|
| Rate for Payer: Three Rivers PPO |
$169.50
|
| Rate for Payer: TriWest Veterans Administration |
$137.86
|
| Rate for Payer: United Healthcare Commercial |
$215.83
|
| Rate for Payer: United Healthcare Medicare |
$137.86
|
| Rate for Payer: WINHealth Partners Commercial |
$214.70
|
| Rate for Payer: Wise Provider Network Commercial |
$214.70
|
|
|
HC CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$221.48
|
| Rate for Payer: Aetna of WY Medicare |
$149.16
|
| Rate for Payer: Altius Commercial |
$216.96
|
| Rate for Payer: Beech Street Commercial |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$219.22
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$219.22
|
| Rate for Payer: Cigna of WY Commercial |
$221.48
|
| Rate for Payer: Entrust Commercial |
$214.70
|
| Rate for Payer: First Choice Health Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.82
|
| Rate for Payer: HealthUtah PPO |
$226.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$219.22
|
| Rate for Payer: Multiplan Medicare/VA |
$122.38
|
| Rate for Payer: One Health Plan of WY PPO |
$221.48
|
| Rate for Payer: PacificSource Commercial |
$203.40
|
| Rate for Payer: PHCS PPO |
$221.48
|
| Rate for Payer: Three Rivers PPO |
$169.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.82
|
| Rate for Payer: United Healthcare Commercial |
$215.83
|
| Rate for Payer: United Healthcare Medicare |
$128.82
|
| Rate for Payer: WINHealth Partners Commercial |
$221.48
|
| Rate for Payer: Wise Provider Network Commercial |
$214.70
|
|
