|
HC LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
7611205101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$195.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.68
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$163.10
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.68
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$171.68
|
| Rate for Payer: WINHealth Partners Commercial |
$290.08
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
|
HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
7611205301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.46
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$270.24
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$284.46
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$284.46
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
7611205301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.48 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$284.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.98
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$237.48
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$249.98
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$249.98
|
| Rate for Payer: WINHealth Partners Commercial |
$422.38
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
7611205401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.79 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.78
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$208.79
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.78
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
7611205401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$219.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.14
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.48
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.14
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$193.14
|
| Rate for Payer: WINHealth Partners Commercial |
$326.34
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
7611204101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$195.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.68
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$163.10
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.68
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$171.68
|
| Rate for Payer: WINHealth Partners Commercial |
$290.08
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
|
HC LAYR CLOS WND REST BODY <2.5 CM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
7611204101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.59 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.36
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$185.59
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$195.36
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$195.36
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
|
HC LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
5101204201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.02
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.52
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.02
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$130.02
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
5101204201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$130.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.12
|
| Rate for Payer: Altius Commercial |
$189.12
|
| Rate for Payer: Beech Street Commercial |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.74
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: Entrust Commercial |
$187.15
|
| Rate for Payer: First Choice Health Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.26
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$108.55
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$193.06
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$114.26
|
| Rate for Payer: WINHealth Partners Commercial |
$193.06
|
| Rate for Payer: Wise Provider Network Commercial |
$187.15
|
|
|
HC LAYR CLOS WND REST BODY 7.6-12.5 CM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
7611204401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$219.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.14
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.48
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.14
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$193.14
|
| Rate for Payer: WINHealth Partners Commercial |
$326.34
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC LAYR CLOS WND REST BODY 7.6-12.5 CM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
7611204401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.79 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.78
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$208.79
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.78
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
7611203501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$381.12
|
| Rate for Payer: Altius Commercial |
$381.12
|
| Rate for Payer: Beech Street Commercial |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$325.94
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: Entrust Commercial |
$377.15
|
| Rate for Payer: First Choice Health Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.02
|
| Rate for Payer: HealthUtah PPO |
$397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Multiplan Medicare/VA |
$248.92
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PHCS PPO |
$389.06
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.02
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: United Healthcare Medicare |
$262.02
|
| Rate for Payer: WINHealth Partners Commercial |
$377.15
|
| Rate for Payer: Wise Provider Network Commercial |
$377.15
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
7611203501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$389.06
|
| Rate for Payer: Aetna of WY Medicare |
$262.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$381.12
|
| Rate for Payer: Altius Commercial |
$381.12
|
| Rate for Payer: Beech Street Commercial |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$325.94
|
| Rate for Payer: Cash Price |
$277.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$385.09
|
| Rate for Payer: Cigna of WY Commercial |
$389.06
|
| Rate for Payer: Entrust Commercial |
$377.15
|
| Rate for Payer: First Choice Health Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$377.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$230.26
|
| Rate for Payer: HealthUtah PPO |
$397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$385.09
|
| Rate for Payer: Multiplan Medicare/VA |
$218.75
|
| Rate for Payer: One Health Plan of WY PPO |
$389.06
|
| Rate for Payer: PacificSource Commercial |
$357.30
|
| Rate for Payer: PHCS PPO |
$389.06
|
| Rate for Payer: Three Rivers PPO |
$297.75
|
| Rate for Payer: TriWest Veterans Administration |
$230.26
|
| Rate for Payer: United Healthcare Commercial |
$345.39
|
| Rate for Payer: United Healthcare Medicare |
$230.26
|
| Rate for Payer: WINHealth Partners Commercial |
$389.06
|
| Rate for Payer: Wise Provider Network Commercial |
$377.15
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
7611203601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.49 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.88
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$387.49
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$407.88
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$407.88
|
| Rate for Payer: WINHealth Partners Commercial |
$587.10
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
7611203601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.52 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$593.28
|
| Rate for Payer: Altius Commercial |
$593.28
|
| Rate for Payer: Beech Street Commercial |
$605.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$507.38
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: Entrust Commercial |
$587.10
|
| Rate for Payer: First Choice Health Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$358.44
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$340.52
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$605.64
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$358.44
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$358.44
|
| Rate for Payer: WINHealth Partners Commercial |
$605.64
|
| Rate for Payer: Wise Provider Network Commercial |
$587.10
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
7611203101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.59 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.36
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$185.59
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$195.36
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$195.36
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
7611203101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$195.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$284.16
|
| Rate for Payer: Altius Commercial |
$284.16
|
| Rate for Payer: Beech Street Commercial |
$290.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.02
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: Entrust Commercial |
$281.20
|
| Rate for Payer: First Choice Health Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.68
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$163.10
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$290.08
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.68
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$171.68
|
| Rate for Payer: WINHealth Partners Commercial |
$290.08
|
| Rate for Payer: Wise Provider Network Commercial |
$281.20
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5101203101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.32
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$95.30
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.32
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$100.32
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
5101203101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$100.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$145.92
|
| Rate for Payer: Altius Commercial |
$145.92
|
| Rate for Payer: Beech Street Commercial |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$124.79
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: Entrust Commercial |
$144.40
|
| Rate for Payer: First Choice Health Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.16
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$83.75
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$148.96
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$88.16
|
| Rate for Payer: United Healthcare Commercial |
$132.24
|
| Rate for Payer: United Healthcare Medicare |
$88.16
|
| Rate for Payer: WINHealth Partners Commercial |
$148.96
|
| Rate for Payer: Wise Provider Network Commercial |
$144.40
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
7611203201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.48 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$284.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.98
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$237.48
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$249.98
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$249.98
|
| Rate for Payer: WINHealth Partners Commercial |
$422.38
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
7611203201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$413.76
|
| Rate for Payer: Altius Commercial |
$413.76
|
| Rate for Payer: Beech Street Commercial |
$422.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.85
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: Entrust Commercial |
$409.45
|
| Rate for Payer: First Choice Health Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.46
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$270.24
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$422.38
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$284.46
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$284.46
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
| Rate for Payer: Wise Provider Network Commercial |
$409.45
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG >30.0 CM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
7611203701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.56 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Aetna of WY Medicare |
$466.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.72
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$410.06
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$389.56
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$410.06
|
| Rate for Payer: United Healthcare Commercial |
$615.09
|
| Rate for Payer: United Healthcare Medicare |
$410.06
|
| Rate for Payer: WINHealth Partners Commercial |
$692.86
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG >30.0 CM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
7611203701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$443.29 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$678.72
|
| Rate for Payer: Altius Commercial |
$678.72
|
| Rate for Payer: Beech Street Commercial |
$692.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: Entrust Commercial |
$671.65
|
| Rate for Payer: First Choice Health Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.62
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$443.29
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$692.86
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$466.62
|
| Rate for Payer: United Healthcare Commercial |
$615.09
|
| Rate for Payer: United Healthcare Medicare |
$466.62
|
| Rate for Payer: WINHealth Partners Commercial |
$671.65
|
| Rate for Payer: Wise Provider Network Commercial |
$671.65
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
7611203401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.79 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.78
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$208.79
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.78
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$219.78
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
|
HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
7611203401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$219.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$319.68
|
| Rate for Payer: Altius Commercial |
$319.68
|
| Rate for Payer: Beech Street Commercial |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$273.39
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: Entrust Commercial |
$316.35
|
| Rate for Payer: First Choice Health Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.14
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.48
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$326.34
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$193.14
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$193.14
|
| Rate for Payer: WINHealth Partners Commercial |
$326.34
|
| Rate for Payer: Wise Provider Network Commercial |
$316.35
|
|
