|
HC CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
5102354501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$281.04 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$508.62
|
| Rate for Payer: Aetna of WY Medicare |
$342.54
|
| Rate for Payer: Altius Commercial |
$498.24
|
| Rate for Payer: Beech Street Commercial |
$508.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$503.43
|
| Rate for Payer: Cash Price |
$363.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$503.43
|
| Rate for Payer: Cigna of WY Commercial |
$508.62
|
| Rate for Payer: Entrust Commercial |
$493.05
|
| Rate for Payer: First Choice Health Commercial |
$493.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$493.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.83
|
| Rate for Payer: HealthUtah PPO |
$519.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$503.43
|
| Rate for Payer: Multiplan Medicare/VA |
$281.04
|
| Rate for Payer: One Health Plan of WY PPO |
$508.62
|
| Rate for Payer: PacificSource Commercial |
$467.10
|
| Rate for Payer: PHCS PPO |
$508.62
|
| Rate for Payer: Three Rivers PPO |
$389.25
|
| Rate for Payer: TriWest Veterans Administration |
$295.83
|
| Rate for Payer: United Healthcare Commercial |
$495.64
|
| Rate for Payer: United Healthcare Medicare |
$295.83
|
| Rate for Payer: WINHealth Partners Commercial |
$508.62
|
| Rate for Payer: Wise Provider Network Commercial |
$493.05
|
|
|
HC CLOSED TX CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
7612354501
|
|
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 CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
7612354501
|
|
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 CLAVICLE DISLOCATION W/MANIPULATION
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
5102354501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$300.76 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$508.62
|
| Rate for Payer: Aetna of WY Medicare |
$332.16
|
| Rate for Payer: Altius Commercial |
$498.24
|
| Rate for Payer: Beech Street Commercial |
$508.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$503.43
|
| Rate for Payer: Cash Price |
$363.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$503.43
|
| Rate for Payer: Cigna of WY Commercial |
$508.62
|
| Rate for Payer: Entrust Commercial |
$493.05
|
| Rate for Payer: First Choice Health Commercial |
$493.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$493.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.59
|
| Rate for Payer: HealthUtah PPO |
$519.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$503.43
|
| Rate for Payer: Multiplan Medicare/VA |
$300.76
|
| Rate for Payer: One Health Plan of WY PPO |
$508.62
|
| Rate for Payer: PacificSource Commercial |
$467.10
|
| Rate for Payer: PHCS PPO |
$508.62
|
| Rate for Payer: Three Rivers PPO |
$389.25
|
| Rate for Payer: TriWest Veterans Administration |
$316.59
|
| Rate for Payer: United Healthcare Commercial |
$495.64
|
| Rate for Payer: United Healthcare Medicare |
$316.59
|
| Rate for Payer: WINHealth Partners Commercial |
$493.05
|
| Rate for Payer: Wise Provider Network Commercial |
$493.05
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
7612350001
|
|
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 CLAVICULAR FX W/O MANIPULATION
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
5102350001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$111.36
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.14
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.14
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$106.14
|
| Rate for Payer: WINHealth Partners Commercial |
$165.30
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
5102350001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.22 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.52
|
| Rate for Payer: Aetna of WY Medicare |
$114.84
|
| Rate for Payer: Altius Commercial |
$167.04
|
| Rate for Payer: Beech Street Commercial |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.78
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.78
|
| Rate for Payer: Cigna of WY Commercial |
$170.52
|
| Rate for Payer: Entrust Commercial |
$165.30
|
| Rate for Payer: First Choice Health Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.18
|
| Rate for Payer: HealthUtah PPO |
$174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.78
|
| Rate for Payer: Multiplan Medicare/VA |
$94.22
|
| Rate for Payer: One Health Plan of WY PPO |
$170.52
|
| Rate for Payer: PacificSource Commercial |
$156.60
|
| Rate for Payer: PHCS PPO |
$170.52
|
| Rate for Payer: Three Rivers PPO |
$130.50
|
| Rate for Payer: TriWest Veterans Administration |
$99.18
|
| Rate for Payer: United Healthcare Commercial |
$166.17
|
| Rate for Payer: United Healthcare Medicare |
$99.18
|
| Rate for Payer: WINHealth Partners Commercial |
$170.52
|
| Rate for Payer: Wise Provider Network Commercial |
$165.30
|
|
|
HC CLOSED TX CLAVICULAR FX W/O MANIPULATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
7612350001
|
|
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 DIST FIBULA FX
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
7612778601
|
|
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 DIST FIBULA FX
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
7612778601
|
|
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 DIST FIBULA FX,MANIP
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
7612778801
|
|
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 DIST FIBULA FX,MANIP
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
7612778801
|
|
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 DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$106.92
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.34
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$87.72
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$92.34
|
| Rate for Payer: United Healthcare Commercial |
$154.71
|
| Rate for Payer: United Healthcare Medicare |
$92.34
|
| Rate for Payer: WINHealth Partners Commercial |
$158.76
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC CLOSED TX DIST RAD FX/EPIPHYSEAL SEP W/O MANIPULATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
5102560001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.76
|
| Rate for Payer: Aetna of WY Medicare |
$103.68
|
| Rate for Payer: Altius Commercial |
$155.52
|
| Rate for Payer: Beech Street Commercial |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$157.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.14
|
| Rate for Payer: Cigna of WY Commercial |
$158.76
|
| Rate for Payer: Entrust Commercial |
$153.90
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.82
|
| Rate for Payer: HealthUtah PPO |
$162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.14
|
| Rate for Payer: Multiplan Medicare/VA |
$93.88
|
| Rate for Payer: One Health Plan of WY PPO |
$158.76
|
| Rate for Payer: PacificSource Commercial |
$145.80
|
| Rate for Payer: PHCS PPO |
$158.76
|
| Rate for Payer: Three Rivers PPO |
$121.50
|
| Rate for Payer: TriWest Veterans Administration |
$98.82
|
| Rate for Payer: United Healthcare Commercial |
$154.71
|
| Rate for Payer: United Healthcare Medicare |
$98.82
|
| Rate for Payer: WINHealth Partners Commercial |
$153.90
|
| Rate for Payer: Wise Provider Network Commercial |
$153.90
|
|
|
HC CLOSED TX DIST RAD/ULNA FX
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
7612560001
|
|
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 DIST RAD/ULNA FX
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
7612560001
|
|
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 DIST RAD/ULNA FX,MANIPUL
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
7612560501
|
|
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 DIST RAD/ULNA FX,MANIPUL
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
7612560501
|
|
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 DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
5102778601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.09 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$226.38
|
| Rate for Payer: Aetna of WY Medicare |
$152.46
|
| Rate for Payer: Altius Commercial |
$221.76
|
| Rate for Payer: Beech Street Commercial |
$226.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.07
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$224.07
|
| Rate for Payer: Cigna of WY Commercial |
$226.38
|
| Rate for Payer: Entrust Commercial |
$219.45
|
| Rate for Payer: First Choice Health Commercial |
$219.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$219.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.67
|
| Rate for Payer: HealthUtah PPO |
$231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$224.07
|
| Rate for Payer: Multiplan Medicare/VA |
$125.09
|
| Rate for Payer: One Health Plan of WY PPO |
$226.38
|
| Rate for Payer: PacificSource Commercial |
$207.90
|
| Rate for Payer: PHCS PPO |
$226.38
|
| Rate for Payer: Three Rivers PPO |
$173.25
|
| Rate for Payer: TriWest Veterans Administration |
$131.67
|
| Rate for Payer: United Healthcare Commercial |
$220.60
|
| Rate for Payer: United Healthcare Medicare |
$131.67
|
| Rate for Payer: WINHealth Partners Commercial |
$226.38
|
| Rate for Payer: Wise Provider Network Commercial |
$219.45
|
|
|
HC CLOSED TX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
5102778601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.86 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$226.38
|
| Rate for Payer: Aetna of WY Medicare |
$147.84
|
| Rate for Payer: Altius Commercial |
$221.76
|
| Rate for Payer: Beech Street Commercial |
$226.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.07
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$224.07
|
| Rate for Payer: Cigna of WY Commercial |
$226.38
|
| Rate for Payer: Entrust Commercial |
$219.45
|
| Rate for Payer: First Choice Health Commercial |
$219.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$219.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.91
|
| Rate for Payer: HealthUtah PPO |
$231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$224.07
|
| Rate for Payer: Multiplan Medicare/VA |
$133.86
|
| Rate for Payer: One Health Plan of WY PPO |
$226.38
|
| Rate for Payer: PacificSource Commercial |
$207.90
|
| Rate for Payer: PHCS PPO |
$226.38
|
| Rate for Payer: Three Rivers PPO |
$173.25
|
| Rate for Payer: TriWest Veterans Administration |
$140.91
|
| Rate for Payer: United Healthcare Commercial |
$220.60
|
| Rate for Payer: United Healthcare Medicare |
$140.91
|
| Rate for Payer: WINHealth Partners Commercial |
$219.45
|
| Rate for Payer: Wise Provider Network Commercial |
$219.45
|
|
|
HC CLOSED TX DSTL TIBIA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
7612782401
|
|
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 DSTL TIBIA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
7612782401
|
|
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 ELBOW DISLOCATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
7612460001
|
|
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 ELBOW DISLOCATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
7612460001
|
|
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 ELBOW DISLOCATN,ANESTHESIA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
7612460501
|
|
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
|
|
