|
HC CLOSED TX ELBOW DISLOCATN,ANESTHESIA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
7612460501
|
|
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 FEMORAL FRACTURE PROX HEAD W/O MANJ
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
7612726701
|
|
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 FEMORAL FRACTURE PROX HEAD W/O MANJ
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
7612726701
|
|
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 FEMORAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
5102750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.02 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$378.28
|
| Rate for Payer: Aetna of WY Medicare |
$254.76
|
| Rate for Payer: Altius Commercial |
$370.56
|
| Rate for Payer: Beech Street Commercial |
$378.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.42
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$374.42
|
| Rate for Payer: Cigna of WY Commercial |
$378.28
|
| Rate for Payer: Entrust Commercial |
$366.70
|
| Rate for Payer: First Choice Health Commercial |
$366.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$366.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.02
|
| Rate for Payer: HealthUtah PPO |
$386.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$374.42
|
| Rate for Payer: Multiplan Medicare/VA |
$209.02
|
| Rate for Payer: One Health Plan of WY PPO |
$378.28
|
| Rate for Payer: PacificSource Commercial |
$347.40
|
| Rate for Payer: PHCS PPO |
$378.28
|
| Rate for Payer: Three Rivers PPO |
$289.50
|
| Rate for Payer: TriWest Veterans Administration |
$220.02
|
| Rate for Payer: United Healthcare Commercial |
$368.63
|
| Rate for Payer: United Healthcare Medicare |
$220.02
|
| Rate for Payer: WINHealth Partners Commercial |
$378.28
|
| Rate for Payer: Wise Provider Network Commercial |
$366.70
|
|
|
HC CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
5102750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$223.69 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$378.28
|
| Rate for Payer: Aetna of WY Medicare |
$247.04
|
| Rate for Payer: Altius Commercial |
$370.56
|
| Rate for Payer: Beech Street Commercial |
$378.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$374.42
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$374.42
|
| Rate for Payer: Cigna of WY Commercial |
$378.28
|
| Rate for Payer: Entrust Commercial |
$366.70
|
| Rate for Payer: First Choice Health Commercial |
$366.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$366.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$235.46
|
| Rate for Payer: HealthUtah PPO |
$386.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$374.42
|
| Rate for Payer: Multiplan Medicare/VA |
$223.69
|
| Rate for Payer: One Health Plan of WY PPO |
$378.28
|
| Rate for Payer: PacificSource Commercial |
$347.40
|
| Rate for Payer: PHCS PPO |
$378.28
|
| Rate for Payer: Three Rivers PPO |
$289.50
|
| Rate for Payer: TriWest Veterans Administration |
$235.46
|
| Rate for Payer: United Healthcare Commercial |
$368.63
|
| Rate for Payer: United Healthcare Medicare |
$235.46
|
| Rate for Payer: WINHealth Partners Commercial |
$366.70
|
| Rate for Payer: Wise Provider Network Commercial |
$366.70
|
|
|
HC CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
7612750001
|
|
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 FEMORAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
7612750001
|
|
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 FEMUR SHAFT FX+MANIP
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
7612750201
|
|
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 FEMUR SHAFT FX+MANIP
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
7612750201
|
|
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 FX GREAT TOE PHLX/PHLG W/O MANJ
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
7612849001
|
|
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 FX GREAT TOE PHLX/PHLG W/O MANJ
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
7612849001
|
|
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 FX GREAT TOE PHLX/PHLG W/O MANJ
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
5102849001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$66.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$54.15
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicare |
$57.00
|
| Rate for Payer: WINHealth Partners Commercial |
$98.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CLOSED TX FX GREAT TOE PHLX/PHLG W/O MANJ
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
5102849001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.95 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$64.00
|
| Rate for Payer: Altius Commercial |
$96.00
|
| Rate for Payer: Beech Street Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: Entrust Commercial |
$95.00
|
| Rate for Payer: First Choice Health Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.00
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$57.95
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$98.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$61.00
|
| Rate for Payer: United Healthcare Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicare |
$61.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
| Rate for Payer: Wise Provider Network Commercial |
$95.00
|
|
|
HC CLOSED TX FX PHLX/PHLG OTH/THN GREAT TOE W/O MANJ
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
5102851001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$62.08
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CLOSED TX FX PHLX/PHLG OTH/THN GREAT TOE W/O MANJ
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 28510
|
| Hospital Charge Code |
5102851001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Aetna of WY Medicare |
$64.02
|
| Rate for Payer: Altius Commercial |
$93.12
|
| Rate for Payer: Beech Street Commercial |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: Entrust Commercial |
$92.15
|
| Rate for Payer: First Choice Health Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.29
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: Multiplan Medicare/VA |
$52.53
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$95.06
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.29
|
| Rate for Payer: United Healthcare Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicare |
$55.29
|
| Rate for Payer: WINHealth Partners Commercial |
$95.06
|
| Rate for Payer: Wise Provider Network Commercial |
$92.15
|
|
|
HC CLOSED TX GREATER TROCHANTERIC FX W/O MANJ
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
5102724601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$389.88 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$475.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$698.40
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.40
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$389.88
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$410.40
|
| Rate for Payer: United Healthcare Commercial |
$687.60
|
| Rate for Payer: United Healthcare Medicare |
$410.40
|
| Rate for Payer: WINHealth Partners Commercial |
$705.60
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC CLOSED TX GREATER TROCHANTERIC FX W/O MANJ
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
5102724601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$417.24 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$460.80
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$698.40
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.20
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$417.24
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$439.20
|
| Rate for Payer: United Healthcare Commercial |
$687.60
|
| Rate for Payer: United Healthcare Medicare |
$439.20
|
| Rate for Payer: WINHealth Partners Commercial |
$684.00
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC CLOSED TX GR TUBEROSITY HUM FX
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
5102362001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Aetna of WY Medicare |
$128.64
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$194.97
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.61
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$116.48
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.61
|
| Rate for Payer: United Healthcare Commercial |
$191.96
|
| Rate for Payer: United Healthcare Medicare |
$122.61
|
| Rate for Payer: WINHealth Partners Commercial |
$190.95
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC CLOSED TX GR TUBEROSITY HUM FX
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
5102362001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.84 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Aetna of WY Medicare |
$132.66
|
| Rate for Payer: Altius Commercial |
$192.96
|
| Rate for Payer: Beech Street Commercial |
$196.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$194.97
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: Entrust Commercial |
$190.95
|
| Rate for Payer: First Choice Health Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.57
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: Multiplan Medicare/VA |
$108.84
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$196.98
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.57
|
| Rate for Payer: United Healthcare Commercial |
$191.96
|
| Rate for Payer: United Healthcare Medicare |
$114.57
|
| Rate for Payer: WINHealth Partners Commercial |
$196.98
|
| Rate for Payer: Wise Provider Network Commercial |
$190.95
|
|
|
HC CLOSED TX HUM EPICONDYLER FX W/O MANIPULATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
7612456001
|
|
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 HUM EPICONDYLER FX W/O MANIPULATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
7612456001
|
|
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 HUMERAL SUPRACONDYLAR FX
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
7612453001
|
|
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 HUMERAL SUPRACONDYLAR FX
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
7612453001
|
|
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 HUMERUS SHAFT FX W/ MANIPULATION
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
5102450001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.57 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Aetna of WY Medicare |
$169.60
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.05
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.65
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$153.57
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.65
|
| Rate for Payer: United Healthcare Commercial |
$253.08
|
| Rate for Payer: United Healthcare Medicare |
$161.65
|
| Rate for Payer: WINHealth Partners Commercial |
$251.75
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
|
HC CLOSED TX HUMERUS SHAFT FX W/ MANIPULATION
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
5102450001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$259.70
|
| Rate for Payer: Aetna of WY Medicare |
$174.90
|
| Rate for Payer: Altius Commercial |
$254.40
|
| Rate for Payer: Beech Street Commercial |
$259.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.05
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.05
|
| Rate for Payer: Cigna of WY Commercial |
$259.70
|
| Rate for Payer: Entrust Commercial |
$251.75
|
| Rate for Payer: First Choice Health Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$251.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.05
|
| Rate for Payer: HealthUtah PPO |
$265.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.05
|
| Rate for Payer: Multiplan Medicare/VA |
$143.50
|
| Rate for Payer: One Health Plan of WY PPO |
$259.70
|
| Rate for Payer: PacificSource Commercial |
$238.50
|
| Rate for Payer: PHCS PPO |
$259.70
|
| Rate for Payer: Three Rivers PPO |
$198.75
|
| Rate for Payer: TriWest Veterans Administration |
$151.05
|
| Rate for Payer: United Healthcare Commercial |
$253.08
|
| Rate for Payer: United Healthcare Medicare |
$151.05
|
| Rate for Payer: WINHealth Partners Commercial |
$259.70
|
| Rate for Payer: Wise Provider Network Commercial |
$251.75
|
|
