|
HC OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
5102778401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.70 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$589.96
|
| Rate for Payer: Aetna of WY Medicare |
$397.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$577.92
|
| Rate for Payer: Altius Commercial |
$577.92
|
| Rate for Payer: Beech Street Commercial |
$589.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$494.24
|
| Rate for Payer: Cash Price |
$421.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$583.94
|
| Rate for Payer: Cigna of WY Commercial |
$589.96
|
| Rate for Payer: Entrust Commercial |
$571.90
|
| Rate for Payer: First Choice Health Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$571.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.16
|
| Rate for Payer: HealthUtah PPO |
$602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$583.94
|
| Rate for Payer: Multiplan Medicare/VA |
$331.70
|
| Rate for Payer: One Health Plan of WY PPO |
$589.96
|
| Rate for Payer: PacificSource Commercial |
$541.80
|
| Rate for Payer: PHCS PPO |
$589.96
|
| Rate for Payer: Three Rivers PPO |
$451.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.16
|
| Rate for Payer: United Healthcare Commercial |
$523.74
|
| Rate for Payer: United Healthcare Medicare |
$349.16
|
| Rate for Payer: WINHealth Partners Commercial |
$589.96
|
| Rate for Payer: Wise Provider Network Commercial |
$571.90
|
|
|
HC OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
5102779201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$381.84 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$596.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$584.64
|
| Rate for Payer: Altius Commercial |
$584.64
|
| Rate for Payer: Beech Street Commercial |
$596.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$499.99
|
| Rate for Payer: Cash Price |
$426.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$590.73
|
| Rate for Payer: Cigna of WY Commercial |
$596.82
|
| Rate for Payer: Entrust Commercial |
$578.55
|
| Rate for Payer: First Choice Health Commercial |
$578.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$578.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.94
|
| Rate for Payer: HealthUtah PPO |
$609.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$590.73
|
| Rate for Payer: Multiplan Medicare/VA |
$381.84
|
| Rate for Payer: One Health Plan of WY PPO |
$596.82
|
| Rate for Payer: PacificSource Commercial |
$548.10
|
| Rate for Payer: PHCS PPO |
$596.82
|
| Rate for Payer: Three Rivers PPO |
$456.75
|
| Rate for Payer: TriWest Veterans Administration |
$401.94
|
| Rate for Payer: United Healthcare Commercial |
$529.83
|
| Rate for Payer: United Healthcare Medicare |
$401.94
|
| Rate for Payer: WINHealth Partners Commercial |
$578.55
|
| Rate for Payer: Wise Provider Network Commercial |
$578.55
|
|
|
HC OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
5102779201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.56 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$596.82
|
| Rate for Payer: Aetna of WY Medicare |
$401.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$584.64
|
| Rate for Payer: Altius Commercial |
$584.64
|
| Rate for Payer: Beech Street Commercial |
$596.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$499.99
|
| Rate for Payer: Cash Price |
$426.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$590.73
|
| Rate for Payer: Cigna of WY Commercial |
$596.82
|
| Rate for Payer: Entrust Commercial |
$578.55
|
| Rate for Payer: First Choice Health Commercial |
$578.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$578.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.22
|
| Rate for Payer: HealthUtah PPO |
$609.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$590.73
|
| Rate for Payer: Multiplan Medicare/VA |
$335.56
|
| Rate for Payer: One Health Plan of WY PPO |
$596.82
|
| Rate for Payer: PacificSource Commercial |
$548.10
|
| Rate for Payer: PHCS PPO |
$596.82
|
| Rate for Payer: Three Rivers PPO |
$456.75
|
| Rate for Payer: TriWest Veterans Administration |
$353.22
|
| Rate for Payer: United Healthcare Commercial |
$529.83
|
| Rate for Payer: United Healthcare Medicare |
$353.22
|
| Rate for Payer: WINHealth Partners Commercial |
$596.82
|
| Rate for Payer: Wise Provider Network Commercial |
$578.55
|
|
|
HC OPEN TX GREATER TROCHANTERIC FX
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
7612724601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OPEN TX GREATER TROCHANTERIC FX
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
7612724601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
7612673501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.46
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$207.54
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.46
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$218.46
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
7612673501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$218.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$317.76
|
| Rate for Payer: Altius Commercial |
$317.76
|
| Rate for Payer: Beech Street Commercial |
$324.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.75
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: Entrust Commercial |
$314.45
|
| Rate for Payer: First Choice Health Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.98
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$182.38
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$324.38
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.98
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$191.98
|
| Rate for Payer: WINHealth Partners Commercial |
$324.38
|
| Rate for Payer: Wise Provider Network Commercial |
$314.45
|
|
|
HC OR BASIC PER MINUTE
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
3600000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Aetna of WY Medicare |
$30.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.16
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.68
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$25.35
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.68
|
| Rate for Payer: United Healthcare Commercial |
$40.02
|
| Rate for Payer: United Healthcare Medicare |
$26.68
|
| Rate for Payer: WINHealth Partners Commercial |
$45.08
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC OR BASIC PER MINUTE
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
3600000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.16
|
| Rate for Payer: Altius Commercial |
$44.16
|
| Rate for Payer: Beech Street Commercial |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.62
|
| Rate for Payer: Cigna of WY Commercial |
$45.08
|
| Rate for Payer: Entrust Commercial |
$43.70
|
| Rate for Payer: First Choice Health Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.36
|
| Rate for Payer: HealthUtah PPO |
$46.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.62
|
| Rate for Payer: Multiplan Medicare/VA |
$28.84
|
| Rate for Payer: One Health Plan of WY PPO |
$45.08
|
| Rate for Payer: PacificSource Commercial |
$41.40
|
| Rate for Payer: PHCS PPO |
$45.08
|
| Rate for Payer: Three Rivers PPO |
$34.50
|
| Rate for Payer: TriWest Veterans Administration |
$30.36
|
| Rate for Payer: United Healthcare Commercial |
$40.02
|
| Rate for Payer: United Healthcare Medicare |
$30.36
|
| Rate for Payer: WINHealth Partners Commercial |
$43.70
|
| Rate for Payer: Wise Provider Network Commercial |
$43.70
|
|
|
HC OR DENTAL EA MIN
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3600000023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC OR DENTAL EA MIN
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3600000023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
HC OR ENDO EA MIN
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
3600000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC OR ENDO EA MIN
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
3600000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
HC OR MAJOR 1 EA MIN
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3600000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC OR MAJOR 1 EA MIN
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3600000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
HC OR MAJOR EA MIN
|
Facility
|
OP
|
$95.00
|
|
| Hospital Charge Code |
3600000021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.10
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$52.34
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$55.10
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$55.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC OR MAJOR EA MIN
|
Facility
|
IP
|
$95.00
|
|
| Hospital Charge Code |
3600000021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.20
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.70
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$59.56
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.70
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare |
$62.70
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
HC OR MINOR EA MIN
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
3600000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.40
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.08
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$46.40
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$46.40
|
| Rate for Payer: WINHealth Partners Commercial |
$78.40
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC OR MINOR EA MIN
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
3600000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$76.80
|
| Rate for Payer: Altius Commercial |
$76.80
|
| Rate for Payer: Beech Street Commercial |
$78.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$65.68
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$77.60
|
| Rate for Payer: Cigna of WY Commercial |
$78.40
|
| Rate for Payer: Entrust Commercial |
$76.00
|
| Rate for Payer: First Choice Health Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.80
|
| Rate for Payer: HealthUtah PPO |
$80.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$77.60
|
| Rate for Payer: Multiplan Medicare/VA |
$50.16
|
| Rate for Payer: One Health Plan of WY PPO |
$78.40
|
| Rate for Payer: PacificSource Commercial |
$72.00
|
| Rate for Payer: PHCS PPO |
$78.40
|
| Rate for Payer: Three Rivers PPO |
$60.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.80
|
| Rate for Payer: United Healthcare Commercial |
$69.60
|
| Rate for Payer: United Healthcare Medicare |
$52.80
|
| Rate for Payer: WINHealth Partners Commercial |
$76.00
|
| Rate for Payer: Wise Provider Network Commercial |
$76.00
|
|
|
HC OR PACKAGE - FLAT FEE
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
3600000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.20 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$293.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.10
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$245.20
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$258.10
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$258.10
|
| Rate for Payer: WINHealth Partners Commercial |
$436.10
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC OR PACKAGE - FLAT FEE
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
3600000010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$427.20
|
| Rate for Payer: Altius Commercial |
$427.20
|
| Rate for Payer: Beech Street Commercial |
$436.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$365.34
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: Entrust Commercial |
$422.75
|
| Rate for Payer: First Choice Health Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.70
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$279.02
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$436.10
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$293.70
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$293.70
|
| Rate for Payer: WINHealth Partners Commercial |
$422.75
|
| Rate for Payer: Wise Provider Network Commercial |
$422.75
|
|
|
HC ORTHOPEDIC PROCEDURE
|
Facility
|
OP
|
$2,845.00
|
|
| Hospital Charge Code |
3600000016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,567.60 |
| Max. Negotiated Rate |
$2,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,788.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,877.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,731.20
|
| Rate for Payer: Altius Commercial |
$2,731.20
|
| Rate for Payer: Beech Street Commercial |
$2,788.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,335.74
|
| Rate for Payer: Cash Price |
$1,991.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,759.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,788.10
|
| Rate for Payer: Entrust Commercial |
$2,702.75
|
| Rate for Payer: First Choice Health Commercial |
$2,702.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,702.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,650.10
|
| Rate for Payer: HealthUtah PPO |
$2,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,759.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,567.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,788.10
|
| Rate for Payer: PacificSource Commercial |
$2,560.50
|
| Rate for Payer: PHCS PPO |
$2,788.10
|
| Rate for Payer: Three Rivers PPO |
$2,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,650.10
|
| Rate for Payer: United Healthcare Commercial |
$2,475.15
|
| Rate for Payer: United Healthcare Medicare |
$1,650.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,788.10
|
| Rate for Payer: Wise Provider Network Commercial |
$2,702.75
|
|
|
HC ORTHOPEDIC PROCEDURE
|
Facility
|
IP
|
$2,845.00
|
|
| Hospital Charge Code |
3600000016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,783.82 |
| Max. Negotiated Rate |
$2,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,788.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,731.20
|
| Rate for Payer: Altius Commercial |
$2,731.20
|
| Rate for Payer: Beech Street Commercial |
$2,788.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,335.74
|
| Rate for Payer: Cash Price |
$1,991.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,759.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,788.10
|
| Rate for Payer: Entrust Commercial |
$2,702.75
|
| Rate for Payer: First Choice Health Commercial |
$2,702.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,702.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,877.70
|
| Rate for Payer: HealthUtah PPO |
$2,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,759.65
|
| Rate for Payer: Multiplan Medicare/VA |
$1,783.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,788.10
|
| Rate for Payer: PacificSource Commercial |
$2,560.50
|
| Rate for Payer: PHCS PPO |
$2,788.10
|
| Rate for Payer: Three Rivers PPO |
$2,133.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,877.70
|
| Rate for Payer: United Healthcare Commercial |
$2,475.15
|
| Rate for Payer: United Healthcare Medicare |
$1,877.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,702.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,702.75
|
|
|
HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
5109776001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
HC ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
5109776001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
