|
HC CLOSED TX METACARPAL FX WO MANIP
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
5102660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$67.84
|
| Rate for Payer: Altius Commercial |
$101.76
|
| Rate for Payer: Beech Street Commercial |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.82
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: Entrust Commercial |
$100.70
|
| Rate for Payer: First Choice Health Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.66
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$61.43
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$103.88
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.66
|
| Rate for Payer: United Healthcare Commercial |
$101.23
|
| Rate for Payer: United Healthcare Medicare |
$64.66
|
| Rate for Payer: WINHealth Partners Commercial |
$100.70
|
| Rate for Payer: Wise Provider Network Commercial |
$100.70
|
|
|
HC CLOSED TX METATARSAL FX W/O MANIPULATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
7612847001
|
|
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 METATARSAL FX W/O MANIPULATION
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: United Healthcare Commercial |
$156.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.72
|
| Rate for Payer: Aetna of WY Medicare |
$104.96
|
| Rate for Payer: Altius Commercial |
$157.44
|
| Rate for Payer: Beech Street Commercial |
$160.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.08
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.08
|
| Rate for Payer: Cigna of WY Commercial |
$160.72
|
| Rate for Payer: Entrust Commercial |
$155.80
|
| Rate for Payer: First Choice Health Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.04
|
| Rate for Payer: HealthUtah PPO |
$164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.08
|
| Rate for Payer: Multiplan Medicare/VA |
$95.04
|
| Rate for Payer: One Health Plan of WY PPO |
$160.72
|
| Rate for Payer: PacificSource Commercial |
$147.60
|
| Rate for Payer: PHCS PPO |
$160.72
|
| Rate for Payer: Three Rivers PPO |
$123.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.04
|
| Rate for Payer: United Healthcare Medicare |
$100.04
|
| Rate for Payer: WINHealth Partners Commercial |
$155.80
|
| Rate for Payer: Wise Provider Network Commercial |
$155.80
|
|
|
HC CLOSED TX METATARSAL FX W/O MANIPULATION
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.72
|
| Rate for Payer: Aetna of WY Medicare |
$108.24
|
| Rate for Payer: Altius Commercial |
$157.44
|
| Rate for Payer: Beech Street Commercial |
$160.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.08
|
| Rate for Payer: Cash Price |
$114.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.08
|
| Rate for Payer: Cigna of WY Commercial |
$160.72
|
| Rate for Payer: Entrust Commercial |
$155.80
|
| Rate for Payer: First Choice Health Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.48
|
| Rate for Payer: HealthUtah PPO |
$164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.08
|
| Rate for Payer: Multiplan Medicare/VA |
$88.81
|
| Rate for Payer: One Health Plan of WY PPO |
$160.72
|
| Rate for Payer: PacificSource Commercial |
$147.60
|
| Rate for Payer: PHCS PPO |
$160.72
|
| Rate for Payer: Three Rivers PPO |
$123.00
|
| Rate for Payer: TriWest Veterans Administration |
$93.48
|
| Rate for Payer: United Healthcare Commercial |
$156.62
|
| Rate for Payer: United Healthcare Medicare |
$93.48
|
| Rate for Payer: WINHealth Partners Commercial |
$160.72
|
| Rate for Payer: Wise Provider Network Commercial |
$155.80
|
|
|
HC CLOSED TX METATARSAL FX W/O MANIPULATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
7612847001
|
|
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 MID HUMERUS FX,MANIPULATN
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
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 MID HUMERUS FX,MANIPULATN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
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 MT-PHAL TOE DISLOCATION
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
7612863001
|
|
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 MT-PHAL TOE DISLOCATION
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
7612863001
|
|
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 NOSE FRACTURE, W/O STABILIZATION
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
7612131501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.82 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$378.84
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.18
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$310.82
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$327.18
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$327.18
|
| Rate for Payer: WINHealth Partners Commercial |
$562.52
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
HC CLOSED TX NOSE FRACTURE, W/O STABILIZATION
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
7612131501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$562.52
|
| Rate for Payer: Aetna of WY Medicare |
$367.36
|
| Rate for Payer: Altius Commercial |
$551.04
|
| Rate for Payer: Beech Street Commercial |
$562.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$556.78
|
| Rate for Payer: Cash Price |
$401.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$556.78
|
| Rate for Payer: Cigna of WY Commercial |
$562.52
|
| Rate for Payer: Entrust Commercial |
$545.30
|
| Rate for Payer: First Choice Health Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$545.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.14
|
| Rate for Payer: HealthUtah PPO |
$574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$556.78
|
| Rate for Payer: Multiplan Medicare/VA |
$332.63
|
| Rate for Payer: One Health Plan of WY PPO |
$562.52
|
| Rate for Payer: PacificSource Commercial |
$516.60
|
| Rate for Payer: PHCS PPO |
$562.52
|
| Rate for Payer: Three Rivers PPO |
$430.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.14
|
| Rate for Payer: United Healthcare Commercial |
$548.17
|
| Rate for Payer: United Healthcare Medicare |
$350.14
|
| Rate for Payer: WINHealth Partners Commercial |
$545.30
|
| Rate for Payer: Wise Provider Network Commercial |
$545.30
|
|
|
HC CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
7612756201
|
|
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 PATELLAR DISLOCATION W/ANESTHESIA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
7612756201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: United Healthcare Commercial |
$435.48
|
| 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 Medicare |
$278.16
|
| Rate for Payer: WINHealth Partners Commercial |
$433.20
|
| Rate for Payer: Wise Provider Network Commercial |
$433.20
|
|
|
HC CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
5102719701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$65.92
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.83
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$59.69
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.83
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$62.83
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC CLOSED TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
5102719701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.77 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.91
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.71
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$55.77
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$58.71
|
| Rate for Payer: United Healthcare Commercial |
$98.36
|
| Rate for Payer: United Healthcare Medicare |
$58.71
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC CLOSED TX POST HIP ARTHRP DISLC REQ W/ANESTH
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
7612726601
|
|
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 POST HIP ARTHRP DISLC REQ W/ANESTH
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
7612726601
|
|
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 POST HIP ARTHRPLAS DISLOC
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
7612726501
|
|
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 POST HIP ARTHRPLAS DISLOC
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
7612726501
|
|
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 PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.46
|
| Rate for Payer: Aetna of WY Medicare |
$145.28
|
| Rate for Payer: Altius Commercial |
$217.92
|
| Rate for Payer: Beech Street Commercial |
$222.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$220.19
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.19
|
| Rate for Payer: Cigna of WY Commercial |
$222.46
|
| Rate for Payer: Entrust Commercial |
$215.65
|
| Rate for Payer: First Choice Health Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.47
|
| Rate for Payer: HealthUtah PPO |
$227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.19
|
| Rate for Payer: Multiplan Medicare/VA |
$131.55
|
| Rate for Payer: One Health Plan of WY PPO |
$222.46
|
| Rate for Payer: PacificSource Commercial |
$204.30
|
| Rate for Payer: PHCS PPO |
$222.46
|
| Rate for Payer: Three Rivers PPO |
$170.25
|
| Rate for Payer: TriWest Veterans Administration |
$138.47
|
| Rate for Payer: United Healthcare Commercial |
$216.78
|
| Rate for Payer: United Healthcare Medicare |
$138.47
|
| Rate for Payer: WINHealth Partners Commercial |
$215.65
|
| Rate for Payer: Wise Provider Network Commercial |
$215.65
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
5102778001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.46
|
| Rate for Payer: Aetna of WY Medicare |
$149.82
|
| Rate for Payer: Altius Commercial |
$217.92
|
| Rate for Payer: Beech Street Commercial |
$222.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$220.19
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.19
|
| Rate for Payer: Cigna of WY Commercial |
$222.46
|
| Rate for Payer: Entrust Commercial |
$215.65
|
| Rate for Payer: First Choice Health Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.39
|
| Rate for Payer: HealthUtah PPO |
$227.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.19
|
| Rate for Payer: Multiplan Medicare/VA |
$122.92
|
| Rate for Payer: One Health Plan of WY PPO |
$222.46
|
| Rate for Payer: PacificSource Commercial |
$204.30
|
| Rate for Payer: PHCS PPO |
$222.46
|
| Rate for Payer: Three Rivers PPO |
$170.25
|
| Rate for Payer: TriWest Veterans Administration |
$129.39
|
| Rate for Payer: United Healthcare Commercial |
$216.78
|
| Rate for Payer: United Healthcare Medicare |
$129.39
|
| Rate for Payer: WINHealth Partners Commercial |
$222.46
|
| Rate for Payer: Wise Provider Network Commercial |
$215.65
|
|
|
HC CLOSED TX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
7612778001
|
|
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 PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
7612778001
|
|
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 PROX HUMERUS FX,MANIP
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
7612360501
|
|
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 PROX HUMERUS FX,MANIP
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
7612360501
|
|
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
|
|
