|
HC REPAIR COMPLEX WND TRUNK EA ADDL <5 CM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
7611310201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.64
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$33.86
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$35.64
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC REPAIR COMPLEX WND TRUNK EA ADDL <5 CM
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
7611310201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$35.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.84
|
| Rate for Payer: Altius Commercial |
$51.84
|
| Rate for Payer: Beech Street Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.33
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: Entrust Commercial |
$51.30
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.32
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$29.75
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$52.92
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: United Healthcare Medicare |
$31.32
|
| Rate for Payer: WINHealth Partners Commercial |
$52.92
|
| Rate for Payer: Wise Provider Network Commercial |
$51.30
|
|
|
HC REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
5101315301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$92.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.20
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$77.14
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$81.20
|
| Rate for Payer: WINHealth Partners Commercial |
$137.20
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
5101315301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$134.40
|
| Rate for Payer: Altius Commercial |
$134.40
|
| Rate for Payer: Beech Street Commercial |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.94
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: Entrust Commercial |
$133.00
|
| Rate for Payer: First Choice Health Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.40
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$87.78
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$137.20
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
| Rate for Payer: Wise Provider Network Commercial |
$133.00
|
|
|
HC REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
7612641001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.82 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.44
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$334.82
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.44
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$352.44
|
| Rate for Payer: WINHealth Partners Commercial |
$507.30
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 26410
|
| Hospital Charge Code |
7612641001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.23 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$523.32
|
| Rate for Payer: Aetna of WY Medicare |
$352.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$512.64
|
| Rate for Payer: Altius Commercial |
$512.64
|
| Rate for Payer: Beech Street Commercial |
$523.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$438.41
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$517.98
|
| Rate for Payer: Cigna of WY Commercial |
$523.32
|
| Rate for Payer: Entrust Commercial |
$507.30
|
| Rate for Payer: First Choice Health Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$507.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.72
|
| Rate for Payer: HealthUtah PPO |
$534.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$517.98
|
| Rate for Payer: Multiplan Medicare/VA |
$294.23
|
| Rate for Payer: One Health Plan of WY PPO |
$523.32
|
| Rate for Payer: PacificSource Commercial |
$480.60
|
| Rate for Payer: PHCS PPO |
$523.32
|
| Rate for Payer: Three Rivers PPO |
$400.50
|
| Rate for Payer: TriWest Veterans Administration |
$309.72
|
| Rate for Payer: United Healthcare Commercial |
$464.58
|
| Rate for Payer: United Healthcare Medicare |
$309.72
|
| Rate for Payer: WINHealth Partners Commercial |
$523.32
|
| Rate for Payer: Wise Provider Network Commercial |
$507.30
|
|
|
HC REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
7612641801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.34 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.52
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$421.34
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.52
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$443.52
|
| Rate for Payer: WINHealth Partners Commercial |
$638.40
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
7612641801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$443.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$645.12
|
| Rate for Payer: Altius Commercial |
$645.12
|
| Rate for Payer: Beech Street Commercial |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$551.71
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: Entrust Commercial |
$638.40
|
| Rate for Payer: First Choice Health Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.76
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$370.27
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$658.56
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$389.76
|
| Rate for Payer: United Healthcare Commercial |
$584.64
|
| Rate for Payer: United Healthcare Medicare |
$389.76
|
| Rate for Payer: WINHealth Partners Commercial |
$658.56
|
| Rate for Payer: Wise Provider Network Commercial |
$638.40
|
|
|
HC REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
5105416301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.54
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$137.31
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.54
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$144.54
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 54163
|
| Hospital Charge Code |
5105416301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$144.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$210.24
|
| Rate for Payer: Altius Commercial |
$210.24
|
| Rate for Payer: Beech Street Commercial |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: Entrust Commercial |
$208.05
|
| Rate for Payer: First Choice Health Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.02
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$120.67
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$214.62
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$127.02
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: United Healthcare Medicare |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$214.62
|
| Rate for Payer: Wise Provider Network Commercial |
$208.05
|
|
|
HC REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
5101205301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Aetna of WY Medicare |
$142.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$207.36
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.34
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.28
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$119.02
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$125.28
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicare |
$125.28
|
| Rate for Payer: WINHealth Partners Commercial |
$211.68
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
5101205301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$211.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$207.36
|
| Rate for Payer: Altius Commercial |
$207.36
|
| Rate for Payer: Beech Street Commercial |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$177.34
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$209.52
|
| Rate for Payer: Cigna of WY Commercial |
$211.68
|
| Rate for Payer: Entrust Commercial |
$205.20
|
| Rate for Payer: First Choice Health Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$205.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.56
|
| Rate for Payer: HealthUtah PPO |
$216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$209.52
|
| Rate for Payer: Multiplan Medicare/VA |
$135.43
|
| Rate for Payer: One Health Plan of WY PPO |
$211.68
|
| Rate for Payer: PacificSource Commercial |
$194.40
|
| Rate for Payer: PHCS PPO |
$211.68
|
| Rate for Payer: Three Rivers PPO |
$162.00
|
| Rate for Payer: TriWest Veterans Administration |
$142.56
|
| Rate for Payer: United Healthcare Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicare |
$142.56
|
| Rate for Payer: WINHealth Partners Commercial |
$205.20
|
| Rate for Payer: Wise Provider Network Commercial |
$205.20
|
|
|
HC REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
5101205401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.77 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$145.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$212.16
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.18
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$121.77
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$128.18
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Medicare |
$128.18
|
| Rate for Payer: WINHealth Partners Commercial |
$216.58
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 12054
|
| Hospital Charge Code |
5101205401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$212.16
|
| Rate for Payer: Altius Commercial |
$212.16
|
| Rate for Payer: Beech Street Commercial |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$181.44
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: Entrust Commercial |
$209.95
|
| Rate for Payer: First Choice Health Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.86
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$138.57
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$216.58
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$145.86
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Medicare |
$145.86
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
| Rate for Payer: Wise Provider Network Commercial |
$209.95
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
5101204501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$330.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$323.52
|
| Rate for Payer: Altius Commercial |
$323.52
|
| Rate for Payer: Beech Street Commercial |
$330.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$276.68
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$326.89
|
| Rate for Payer: Cigna of WY Commercial |
$330.26
|
| Rate for Payer: Entrust Commercial |
$320.15
|
| Rate for Payer: First Choice Health Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.42
|
| Rate for Payer: HealthUtah PPO |
$337.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$326.89
|
| Rate for Payer: Multiplan Medicare/VA |
$211.30
|
| Rate for Payer: One Health Plan of WY PPO |
$330.26
|
| Rate for Payer: PacificSource Commercial |
$303.30
|
| Rate for Payer: PHCS PPO |
$330.26
|
| Rate for Payer: Three Rivers PPO |
$252.75
|
| Rate for Payer: TriWest Veterans Administration |
$222.42
|
| Rate for Payer: United Healthcare Commercial |
$293.19
|
| Rate for Payer: United Healthcare Medicare |
$222.42
|
| Rate for Payer: WINHealth Partners Commercial |
$320.15
|
| Rate for Payer: Wise Provider Network Commercial |
$320.15
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
5101204501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.69 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$330.26
|
| Rate for Payer: Aetna of WY Medicare |
$222.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$323.52
|
| Rate for Payer: Altius Commercial |
$323.52
|
| Rate for Payer: Beech Street Commercial |
$330.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$276.68
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$326.89
|
| Rate for Payer: Cigna of WY Commercial |
$330.26
|
| Rate for Payer: Entrust Commercial |
$320.15
|
| Rate for Payer: First Choice Health Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$195.46
|
| Rate for Payer: HealthUtah PPO |
$337.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$326.89
|
| Rate for Payer: Multiplan Medicare/VA |
$185.69
|
| Rate for Payer: One Health Plan of WY PPO |
$330.26
|
| Rate for Payer: PacificSource Commercial |
$303.30
|
| Rate for Payer: PHCS PPO |
$330.26
|
| Rate for Payer: Three Rivers PPO |
$252.75
|
| Rate for Payer: TriWest Veterans Administration |
$195.46
|
| Rate for Payer: United Healthcare Commercial |
$293.19
|
| Rate for Payer: United Healthcare Medicare |
$195.46
|
| Rate for Payer: WINHealth Partners Commercial |
$330.26
|
| Rate for Payer: Wise Provider Network Commercial |
$320.15
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5101204101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Aetna of WY Medicare |
$97.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.26
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$81.00
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$85.26
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: WINHealth Partners Commercial |
$144.06
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
5101204101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$144.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$141.12
|
| Rate for Payer: Altius Commercial |
$141.12
|
| Rate for Payer: Beech Street Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.69
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$142.59
|
| Rate for Payer: Cigna of WY Commercial |
$144.06
|
| Rate for Payer: Entrust Commercial |
$139.65
|
| Rate for Payer: First Choice Health Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$139.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.02
|
| Rate for Payer: HealthUtah PPO |
$147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$142.59
|
| Rate for Payer: Multiplan Medicare/VA |
$92.17
|
| Rate for Payer: One Health Plan of WY PPO |
$144.06
|
| Rate for Payer: PacificSource Commercial |
$132.30
|
| Rate for Payer: PHCS PPO |
$144.06
|
| Rate for Payer: Three Rivers PPO |
$110.25
|
| Rate for Payer: TriWest Veterans Administration |
$97.02
|
| Rate for Payer: United Healthcare Commercial |
$127.89
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
| Rate for Payer: WINHealth Partners Commercial |
$139.65
|
| Rate for Payer: Wise Provider Network Commercial |
$139.65
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
7611204201
|
|
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 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 12042
|
| Hospital Charge Code |
7611204201
|
|
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 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5101204401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$141.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$124.70
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$118.46
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$124.70
|
| Rate for Payer: WINHealth Partners Commercial |
$210.70
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
5101204401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$206.40
|
| Rate for Payer: Altius Commercial |
$206.40
|
| Rate for Payer: Beech Street Commercial |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$176.52
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: Entrust Commercial |
$204.25
|
| Rate for Payer: First Choice Health Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.90
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$134.80
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$210.70
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$141.90
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
| Rate for Payer: Wise Provider Network Commercial |
$204.25
|
|
|
HC REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5101203501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.11 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.36
|
| Rate for Payer: Altius Commercial |
$231.36
|
| Rate for Payer: Beech Street Commercial |
$236.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.86
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: Entrust Commercial |
$228.95
|
| Rate for Payer: First Choice Health Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.06
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$151.11
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$236.18
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$159.06
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$159.06
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
| Rate for Payer: Wise Provider Network Commercial |
$228.95
|
|
|
HC REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 12035
|
| Hospital Charge Code |
5101203501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Aetna of WY Medicare |
$159.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$231.36
|
| Rate for Payer: Altius Commercial |
$231.36
|
| Rate for Payer: Beech Street Commercial |
$236.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$197.86
|
| Rate for Payer: Cash Price |
$168.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$233.77
|
| Rate for Payer: Cigna of WY Commercial |
$236.18
|
| Rate for Payer: Entrust Commercial |
$228.95
|
| Rate for Payer: First Choice Health Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.78
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$132.79
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$236.18
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$139.78
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$139.78
|
| Rate for Payer: WINHealth Partners Commercial |
$236.18
|
| Rate for Payer: Wise Provider Network Commercial |
$228.95
|
|
|
HC REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
5101203401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$135.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$197.76
|
| Rate for Payer: Altius Commercial |
$197.76
|
| Rate for Payer: Beech Street Commercial |
$201.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.13
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: Entrust Commercial |
$195.70
|
| Rate for Payer: First Choice Health Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.48
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$113.51
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$201.88
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.48
|
| Rate for Payer: United Healthcare Commercial |
$179.22
|
| Rate for Payer: United Healthcare Medicare |
$119.48
|
| Rate for Payer: WINHealth Partners Commercial |
$201.88
|
| Rate for Payer: Wise Provider Network Commercial |
$195.70
|
|
