|
DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$6,539.00
|
|
|
Service Code
|
HCPCS 27602 AS
|
| Hospital Charge Code |
27602
|
| Min. Negotiated Rate |
$383.94 |
| Max. Negotiated Rate |
$6,539.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,408.22
|
| Rate for Payer: Aetna of WY Medicare |
$451.69
|
| Rate for Payer: Beech Street Commercial |
$6,212.05
|
| Rate for Payer: Cash Price |
$4,577.30
|
| Rate for Payer: Cash Price |
$4,577.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,342.83
|
| Rate for Payer: Cigna of WY Commercial |
$6,408.22
|
| Rate for Payer: First Choice Health Commercial |
$5,885.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,212.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$451.69
|
| Rate for Payer: HealthUtah PPO |
$6,539.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,342.83
|
| Rate for Payer: Multiplan Medicare/VA |
$383.94
|
| Rate for Payer: One Health Plan of WY PPO |
$6,408.22
|
| Rate for Payer: PacificSource Commercial |
$5,885.10
|
| Rate for Payer: PHCS PPO |
$6,212.05
|
| Rate for Payer: Three Rivers PPO |
$4,904.25
|
| Rate for Payer: TriWest Veterans Administration |
$451.69
|
| Rate for Payer: United Healthcare Commercial |
$5,688.93
|
| Rate for Payer: United Healthcare Medicare |
$451.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,558.15
|
|
|
DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$6,539.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
27602
|
| Min. Negotiated Rate |
$383.94 |
| Max. Negotiated Rate |
$6,539.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,408.22
|
| Rate for Payer: Aetna of WY Medicare |
$451.69
|
| Rate for Payer: Beech Street Commercial |
$6,212.05
|
| Rate for Payer: Cash Price |
$4,577.30
|
| Rate for Payer: Cash Price |
$4,577.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,342.83
|
| Rate for Payer: Cigna of WY Commercial |
$6,408.22
|
| Rate for Payer: First Choice Health Commercial |
$5,885.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,212.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$451.69
|
| Rate for Payer: HealthUtah PPO |
$6,539.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,342.83
|
| Rate for Payer: Multiplan Medicare/VA |
$383.94
|
| Rate for Payer: One Health Plan of WY PPO |
$6,408.22
|
| Rate for Payer: PacificSource Commercial |
$5,885.10
|
| Rate for Payer: PHCS PPO |
$6,212.05
|
| Rate for Payer: Three Rivers PPO |
$4,904.25
|
| Rate for Payer: TriWest Veterans Administration |
$451.69
|
| Rate for Payer: United Healthcare Commercial |
$5,688.93
|
| Rate for Payer: United Healthcare Medicare |
$451.69
|
| Rate for Payer: WINHealth Partners Commercial |
$5,558.15
|
|
|
DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,418.00
|
|
|
Service Code
|
HCPCS 62287 80
|
| Hospital Charge Code |
62287
|
| Min. Negotiated Rate |
$496.52 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,369.64
|
| Rate for Payer: Aetna of WY Medicare |
$584.14
|
| Rate for Payer: Beech Street Commercial |
$2,297.10
|
| Rate for Payer: Cash Price |
$1,692.60
|
| Rate for Payer: Cash Price |
$1,692.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,345.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,369.64
|
| Rate for Payer: First Choice Health Commercial |
$2,176.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,297.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$584.14
|
| Rate for Payer: HealthUtah PPO |
$2,418.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,345.46
|
| Rate for Payer: Multiplan Medicare/VA |
$496.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,369.64
|
| Rate for Payer: PacificSource Commercial |
$2,176.20
|
| Rate for Payer: PHCS PPO |
$2,297.10
|
| Rate for Payer: Three Rivers PPO |
$1,813.50
|
| Rate for Payer: TriWest Veterans Administration |
$584.14
|
| Rate for Payer: United Healthcare Commercial |
$2,103.66
|
| Rate for Payer: United Healthcare Medicare |
$584.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,055.30
|
|
|
DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,418.00
|
|
|
Service Code
|
HCPCS 62287 AS
|
| Hospital Charge Code |
62287
|
| Min. Negotiated Rate |
$496.52 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,369.64
|
| Rate for Payer: Aetna of WY Medicare |
$584.14
|
| Rate for Payer: Beech Street Commercial |
$2,297.10
|
| Rate for Payer: Cash Price |
$1,692.60
|
| Rate for Payer: Cash Price |
$1,692.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,345.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,369.64
|
| Rate for Payer: First Choice Health Commercial |
$2,176.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,297.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$584.14
|
| Rate for Payer: HealthUtah PPO |
$2,418.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,345.46
|
| Rate for Payer: Multiplan Medicare/VA |
$496.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2,369.64
|
| Rate for Payer: PacificSource Commercial |
$2,176.20
|
| Rate for Payer: PHCS PPO |
$2,297.10
|
| Rate for Payer: Three Rivers PPO |
$1,813.50
|
| Rate for Payer: TriWest Veterans Administration |
$584.14
|
| Rate for Payer: United Healthcare Commercial |
$2,103.66
|
| Rate for Payer: United Healthcare Medicare |
$584.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,055.30
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 11044 80
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$1,138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,115.24
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$1,081.10
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,115.24
|
| Rate for Payer: First Choice Health Commercial |
$1,024.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,081.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$1,138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.86
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,115.24
|
| Rate for Payer: PacificSource Commercial |
$1,024.20
|
| Rate for Payer: PHCS PPO |
$1,081.10
|
| Rate for Payer: Three Rivers PPO |
$853.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$990.06
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$967.30
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$1,138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,115.24
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$1,081.10
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,115.24
|
| Rate for Payer: First Choice Health Commercial |
$1,024.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,081.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$1,138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.86
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,115.24
|
| Rate for Payer: PacificSource Commercial |
$1,024.20
|
| Rate for Payer: PHCS PPO |
$1,081.10
|
| Rate for Payer: Three Rivers PPO |
$853.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$990.06
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$967.30
|
|
|
DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 11044 AS
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$1,138.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,115.24
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Beech Street Commercial |
$1,081.10
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: Cash Price |
$796.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,115.24
|
| Rate for Payer: First Choice Health Commercial |
$1,024.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,081.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.40
|
| Rate for Payer: HealthUtah PPO |
$1,138.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.86
|
| Rate for Payer: Multiplan Medicare/VA |
$182.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,115.24
|
| Rate for Payer: PacificSource Commercial |
$1,024.20
|
| Rate for Payer: PHCS PPO |
$1,081.10
|
| Rate for Payer: Three Rivers PPO |
$853.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.40
|
| Rate for Payer: United Healthcare Commercial |
$990.06
|
| Rate for Payer: United Healthcare Medicare |
$214.40
|
| Rate for Payer: WINHealth Partners Commercial |
$967.30
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
69222
|
| Min. Negotiated Rate |
$113.70 |
| Max. Negotiated Rate |
$683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$669.34
|
| Rate for Payer: Aetna of WY Medicare |
$133.77
|
| Rate for Payer: Beech Street Commercial |
$648.85
|
| Rate for Payer: Cash Price |
$478.10
|
| Rate for Payer: Cash Price |
$478.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.51
|
| Rate for Payer: Cigna of WY Commercial |
$669.34
|
| Rate for Payer: First Choice Health Commercial |
$614.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.77
|
| Rate for Payer: HealthUtah PPO |
$683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.51
|
| Rate for Payer: Multiplan Medicare/VA |
$113.70
|
| Rate for Payer: One Health Plan of WY PPO |
$669.34
|
| Rate for Payer: PacificSource Commercial |
$614.70
|
| Rate for Payer: PHCS PPO |
$648.85
|
| Rate for Payer: Three Rivers PPO |
$512.25
|
| Rate for Payer: TriWest Veterans Administration |
$133.77
|
| Rate for Payer: United Healthcare Commercial |
$594.21
|
| Rate for Payer: United Healthcare Medicare |
$133.77
|
| Rate for Payer: WINHealth Partners Commercial |
$580.55
|
|
|
DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 69220
|
| Hospital Charge Code |
69220
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Aetna of WY Medicare |
$49.40
|
| Rate for Payer: Beech Street Commercial |
$247.95
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.17
|
| Rate for Payer: Cigna of WY Commercial |
$255.78
|
| Rate for Payer: First Choice Health Commercial |
$234.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.40
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Multiplan Medicare/VA |
$41.99
|
| Rate for Payer: One Health Plan of WY PPO |
$255.78
|
| Rate for Payer: PacificSource Commercial |
$234.90
|
| Rate for Payer: PHCS PPO |
$247.95
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: TriWest Veterans Administration |
$49.40
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare |
$49.40
|
| Rate for Payer: WINHealth Partners Commercial |
$221.85
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 11043 80
|
| Hospital Charge Code |
11043
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$146.55
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
11043
|
| Min. Negotiated Rate |
$124.57 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$146.55
|
| Rate for Payer: Beech Street Commercial |
$764.75
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: First Choice Health Commercial |
$724.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.55
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$124.57
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$764.75
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$146.55
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$146.55
|
| Rate for Payer: WINHealth Partners Commercial |
$684.25
|
|
|
DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
11046
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.75
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.75
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.99
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$51.75
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
DEBRIDEMENT NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
11720
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Aetna of WY Medicare |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: Multiplan Medicare/VA |
$11.48
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
|
|
DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
97597
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$323.40
|
| Rate for Payer: Aetna of WY Medicare |
$33.87
|
| Rate for Payer: Beech Street Commercial |
$313.50
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$320.10
|
| Rate for Payer: Cigna of WY Commercial |
$323.40
|
| Rate for Payer: First Choice Health Commercial |
$297.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$313.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.87
|
| Rate for Payer: HealthUtah PPO |
$330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$320.10
|
| Rate for Payer: Multiplan Medicare/VA |
$28.79
|
| Rate for Payer: One Health Plan of WY PPO |
$323.40
|
| Rate for Payer: PacificSource Commercial |
$297.00
|
| Rate for Payer: PHCS PPO |
$313.50
|
| Rate for Payer: Three Rivers PPO |
$247.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.87
|
| Rate for Payer: United Healthcare Commercial |
$287.10
|
| Rate for Payer: United Healthcare Medicare |
$33.87
|
| Rate for Payer: WINHealth Partners Commercial |
$313.50
|
|
|
DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
97598
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$184.24
|
| Rate for Payer: Aetna of WY Medicare |
$23.39
|
| Rate for Payer: Beech Street Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$182.36
|
| Rate for Payer: Cigna of WY Commercial |
$184.24
|
| Rate for Payer: First Choice Health Commercial |
$169.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$178.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.39
|
| Rate for Payer: HealthUtah PPO |
$188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$182.36
|
| Rate for Payer: Multiplan Medicare/VA |
$19.88
|
| Rate for Payer: One Health Plan of WY PPO |
$184.24
|
| Rate for Payer: PacificSource Commercial |
$169.20
|
| Rate for Payer: PHCS PPO |
$178.60
|
| Rate for Payer: Three Rivers PPO |
$141.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.39
|
| Rate for Payer: United Healthcare Commercial |
$163.56
|
| Rate for Payer: United Healthcare Medicare |
$23.39
|
| Rate for Payer: WINHealth Partners Commercial |
$178.60
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.96
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Beech Street Commercial |
$429.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$438.44
|
| Rate for Payer: Cigna of WY Commercial |
$442.96
|
| Rate for Payer: First Choice Health Commercial |
$406.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$429.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: HealthUtah PPO |
$452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$438.44
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: One Health Plan of WY PPO |
$442.96
|
| Rate for Payer: PacificSource Commercial |
$406.80
|
| Rate for Payer: PHCS PPO |
$429.40
|
| Rate for Payer: Three Rivers PPO |
$339.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$393.24
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
| Rate for Payer: WINHealth Partners Commercial |
$384.20
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 11042 80
|
| Hospital Charge Code |
11042
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.96
|
| Rate for Payer: Aetna of WY Medicare |
$58.16
|
| Rate for Payer: Beech Street Commercial |
$429.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: Cash Price |
$316.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$438.44
|
| Rate for Payer: Cigna of WY Commercial |
$442.96
|
| Rate for Payer: First Choice Health Commercial |
$406.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$429.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.16
|
| Rate for Payer: HealthUtah PPO |
$452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$438.44
|
| Rate for Payer: Multiplan Medicare/VA |
$49.44
|
| Rate for Payer: One Health Plan of WY PPO |
$442.96
|
| Rate for Payer: PacificSource Commercial |
$406.80
|
| Rate for Payer: PHCS PPO |
$429.40
|
| Rate for Payer: Three Rivers PPO |
$339.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.16
|
| Rate for Payer: United Healthcare Commercial |
$393.24
|
| Rate for Payer: United Healthcare Medicare |
$58.16
|
| Rate for Payer: WINHealth Partners Commercial |
$384.20
|
|
|
DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
11045
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.87
|
| Rate for Payer: Beech Street Commercial |
$128.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: First Choice Health Commercial |
$121.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.87
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.29
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$128.25
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.87
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$23.87
|
| Rate for Payer: WINHealth Partners Commercial |
$114.75
|
|
|
DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$4,117.00
|
|
|
Service Code
|
HCPCS 24495
|
| Hospital Charge Code |
24495
|
| Min. Negotiated Rate |
$763.76 |
| Max. Negotiated Rate |
$4,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,034.66
|
| Rate for Payer: Aetna of WY Medicare |
$898.54
|
| Rate for Payer: Beech Street Commercial |
$3,911.15
|
| Rate for Payer: Cash Price |
$2,881.90
|
| Rate for Payer: Cash Price |
$2,881.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,993.49
|
| Rate for Payer: Cigna of WY Commercial |
$4,034.66
|
| Rate for Payer: First Choice Health Commercial |
$3,705.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,911.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$898.54
|
| Rate for Payer: HealthUtah PPO |
$4,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,993.49
|
| Rate for Payer: Multiplan Medicare/VA |
$763.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,034.66
|
| Rate for Payer: PacificSource Commercial |
$3,705.30
|
| Rate for Payer: PHCS PPO |
$3,911.15
|
| Rate for Payer: Three Rivers PPO |
$3,087.75
|
| Rate for Payer: TriWest Veterans Administration |
$898.54
|
| Rate for Payer: United Healthcare Commercial |
$3,581.79
|
| Rate for Payer: United Healthcare Medicare |
$898.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,499.45
|
|
|
DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$4,117.00
|
|
|
Service Code
|
HCPCS 24495 80
|
| Hospital Charge Code |
24495
|
| Min. Negotiated Rate |
$763.76 |
| Max. Negotiated Rate |
$4,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,034.66
|
| Rate for Payer: Aetna of WY Medicare |
$898.54
|
| Rate for Payer: Beech Street Commercial |
$3,911.15
|
| Rate for Payer: Cash Price |
$2,881.90
|
| Rate for Payer: Cash Price |
$2,881.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,993.49
|
| Rate for Payer: Cigna of WY Commercial |
$4,034.66
|
| Rate for Payer: First Choice Health Commercial |
$3,705.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,911.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$898.54
|
| Rate for Payer: HealthUtah PPO |
$4,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,993.49
|
| Rate for Payer: Multiplan Medicare/VA |
$763.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4,034.66
|
| Rate for Payer: PacificSource Commercial |
$3,705.30
|
| Rate for Payer: PHCS PPO |
$3,911.15
|
| Rate for Payer: Three Rivers PPO |
$3,087.75
|
| Rate for Payer: TriWest Veterans Administration |
$898.54
|
| Rate for Payer: United Healthcare Commercial |
$3,581.79
|
| Rate for Payer: United Healthcare Medicare |
$898.54
|
| Rate for Payer: WINHealth Partners Commercial |
$3,499.45
|
|
|
DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
64722
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,816.92
|
| Rate for Payer: Aetna of WY Medicare |
$360.95
|
| Rate for Payer: Beech Street Commercial |
$1,761.30
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,798.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,816.92
|
| Rate for Payer: First Choice Health Commercial |
$1,668.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,761.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.95
|
| Rate for Payer: HealthUtah PPO |
$1,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,798.38
|
| Rate for Payer: Multiplan Medicare/VA |
$306.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,816.92
|
| Rate for Payer: PacificSource Commercial |
$1,668.60
|
| Rate for Payer: PHCS PPO |
$1,761.30
|
| Rate for Payer: Three Rivers PPO |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration |
$360.95
|
| Rate for Payer: United Healthcare Commercial |
$1,612.98
|
| Rate for Payer: United Healthcare Medicare |
$360.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.90
|
|
|
DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 64722 AS
|
| Hospital Charge Code |
64722
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,816.92
|
| Rate for Payer: Aetna of WY Medicare |
$360.95
|
| Rate for Payer: Beech Street Commercial |
$1,761.30
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,798.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,816.92
|
| Rate for Payer: First Choice Health Commercial |
$1,668.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,761.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.95
|
| Rate for Payer: HealthUtah PPO |
$1,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,798.38
|
| Rate for Payer: Multiplan Medicare/VA |
$306.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,816.92
|
| Rate for Payer: PacificSource Commercial |
$1,668.60
|
| Rate for Payer: PHCS PPO |
$1,761.30
|
| Rate for Payer: Three Rivers PPO |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration |
$360.95
|
| Rate for Payer: United Healthcare Commercial |
$1,612.98
|
| Rate for Payer: United Healthcare Medicare |
$360.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.90
|
|
|
DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 64722 80
|
| Hospital Charge Code |
64722
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,816.92
|
| Rate for Payer: Aetna of WY Medicare |
$360.95
|
| Rate for Payer: Beech Street Commercial |
$1,761.30
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,798.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,816.92
|
| Rate for Payer: First Choice Health Commercial |
$1,668.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,761.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.95
|
| Rate for Payer: HealthUtah PPO |
$1,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,798.38
|
| Rate for Payer: Multiplan Medicare/VA |
$306.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,816.92
|
| Rate for Payer: PacificSource Commercial |
$1,668.60
|
| Rate for Payer: PHCS PPO |
$1,761.30
|
| Rate for Payer: Three Rivers PPO |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration |
$360.95
|
| Rate for Payer: United Healthcare Commercial |
$1,612.98
|
| Rate for Payer: United Healthcare Medicare |
$360.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.90
|
|
|
DECOMPRESSIVE FASCIOTOMY HAND
|
Professional
|
Both
|
$2,921.00
|
|
|
Service Code
|
HCPCS 26037
|
| Hospital Charge Code |
26037
|
| Min. Negotiated Rate |
$466.10 |
| Max. Negotiated Rate |
$2,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,862.58
|
| Rate for Payer: Aetna of WY Medicare |
$548.35
|
| Rate for Payer: Beech Street Commercial |
$2,774.95
|
| Rate for Payer: Cash Price |
$2,044.70
|
| Rate for Payer: Cash Price |
$2,044.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,833.37
|
| Rate for Payer: Cigna of WY Commercial |
$2,862.58
|
| Rate for Payer: First Choice Health Commercial |
$2,628.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,774.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$548.35
|
| Rate for Payer: HealthUtah PPO |
$2,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,833.37
|
| Rate for Payer: Multiplan Medicare/VA |
$466.10
|
| Rate for Payer: One Health Plan of WY PPO |
$2,862.58
|
| Rate for Payer: PacificSource Commercial |
$2,628.90
|
| Rate for Payer: PHCS PPO |
$2,774.95
|
| Rate for Payer: Three Rivers PPO |
$2,190.75
|
| Rate for Payer: TriWest Veterans Administration |
$548.35
|
| Rate for Payer: United Healthcare Commercial |
$2,541.27
|
| Rate for Payer: United Healthcare Medicare |
$548.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,482.85
|
|
|
DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 99465
|
| Hospital Charge Code |
99465
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$572.32
|
| Rate for Payer: Aetna of WY Medicare |
$136.14
|
| Rate for Payer: Beech Street Commercial |
$554.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$566.48
|
| Rate for Payer: Cigna of WY Commercial |
$572.32
|
| Rate for Payer: First Choice Health Commercial |
$525.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$554.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.14
|
| Rate for Payer: HealthUtah PPO |
$584.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$566.48
|
| Rate for Payer: Multiplan Medicare/VA |
$115.72
|
| Rate for Payer: One Health Plan of WY PPO |
$572.32
|
| Rate for Payer: PacificSource Commercial |
$525.60
|
| Rate for Payer: PHCS PPO |
$554.80
|
| Rate for Payer: Three Rivers PPO |
$438.00
|
| Rate for Payer: TriWest Veterans Administration |
$136.14
|
| Rate for Payer: United Healthcare Commercial |
$508.08
|
| Rate for Payer: United Healthcare Medicare |
$136.14
|
| Rate for Payer: WINHealth Partners Commercial |
$554.80
|
|
