|
HC PRO ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 99498 NONPBBPAYER
|
| Hospital Charge Code |
9839949801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.34
|
| Rate for Payer: Beech Street Commercial |
$78.85
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.51
|
| Rate for Payer: Cigna of WY Commercial |
$81.34
|
| Rate for Payer: First Choice Health Commercial |
$74.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.85
|
| Rate for Payer: HealthUtah PPO |
$83.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.51
|
| Rate for Payer: One Health Plan of WY PPO |
$81.34
|
| Rate for Payer: PacificSource Commercial |
$74.70
|
| Rate for Payer: PHCS PPO |
$78.85
|
| Rate for Payer: Three Rivers PPO |
$62.25
|
| Rate for Payer: United Healthcare Commercial |
$72.21
|
| Rate for Payer: WINHealth Partners Commercial |
$78.85
|
|
|
HC PRO ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99497 NONPBBPAYER
|
| Hospital Charge Code |
9839949701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$72.49
|
| Rate for Payer: Beech Street Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: First Choice Health Commercial |
$122.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.49
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$61.62
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$129.20
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.49
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$72.49
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
|
|
HC PRO AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 59000 NONPBBPAYER
|
| Hospital Charge Code |
9835900001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$236.18
|
| Rate for Payer: Aetna of WY Medicare |
$76.15
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Cash Price |
$168.70
|
| 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: First Choice Health Commercial |
$216.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.15
|
| Rate for Payer: HealthUtah PPO |
$241.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$233.77
|
| Rate for Payer: Multiplan Medicare/VA |
$64.73
|
| Rate for Payer: One Health Plan of WY PPO |
$236.18
|
| Rate for Payer: PacificSource Commercial |
$216.90
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: Three Rivers PPO |
$180.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.15
|
| Rate for Payer: United Healthcare Commercial |
$209.67
|
| Rate for Payer: United Healthcare Medicare |
$76.15
|
| Rate for Payer: WINHealth Partners Commercial |
$204.85
|
|
|
HC PRO AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
9835900001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.14
|
| Rate for Payer: Aetna of WY Medicare |
$76.15
|
| Rate for Payer: Beech Street Commercial |
$183.35
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.21
|
| Rate for Payer: Cigna of WY Commercial |
$189.14
|
| Rate for Payer: First Choice Health Commercial |
$173.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.15
|
| Rate for Payer: HealthUtah PPO |
$193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.21
|
| Rate for Payer: Multiplan Medicare/VA |
$64.73
|
| Rate for Payer: One Health Plan of WY PPO |
$189.14
|
| Rate for Payer: PacificSource Commercial |
$173.70
|
| Rate for Payer: PHCS PPO |
$183.35
|
| Rate for Payer: Three Rivers PPO |
$144.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.15
|
| Rate for Payer: United Healthcare Commercial |
$167.91
|
| Rate for Payer: United Healthcare Medicare |
$76.15
|
| Rate for Payer: WINHealth Partners Commercial |
$164.05
|
|
|
HC PRO AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,393.00
|
|
|
Service Code
|
HCPCS 26952
|
| Hospital Charge Code |
9832695201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$569.98 |
| Max. Negotiated Rate |
$2,393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,345.14
|
| Rate for Payer: Aetna of WY Medicare |
$670.57
|
| Rate for Payer: Beech Street Commercial |
$2,273.35
|
| Rate for Payer: Cash Price |
$1,675.10
|
| Rate for Payer: Cash Price |
$1,675.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,321.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,345.14
|
| Rate for Payer: First Choice Health Commercial |
$2,153.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,273.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$670.57
|
| Rate for Payer: HealthUtah PPO |
$2,393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,321.21
|
| Rate for Payer: Multiplan Medicare/VA |
$569.98
|
| Rate for Payer: One Health Plan of WY PPO |
$2,345.14
|
| Rate for Payer: PacificSource Commercial |
$2,153.70
|
| Rate for Payer: PHCS PPO |
$2,273.35
|
| Rate for Payer: Three Rivers PPO |
$1,794.75
|
| Rate for Payer: TriWest Veterans Administration |
$670.57
|
| Rate for Payer: United Healthcare Commercial |
$2,081.91
|
| Rate for Payer: United Healthcare Medicare |
$670.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,034.05
|
|
|
HC PRO AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
9752788601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$524.98 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,159.92
|
| Rate for Payer: Aetna of WY Medicare |
$617.62
|
| Rate for Payer: Beech Street Commercial |
$2,093.80
|
| Rate for Payer: Cash Price |
$1,542.80
|
| Rate for Payer: Cash Price |
$1,542.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,137.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,159.92
|
| Rate for Payer: First Choice Health Commercial |
$1,983.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,093.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$617.62
|
| Rate for Payer: HealthUtah PPO |
$2,204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,137.88
|
| Rate for Payer: Multiplan Medicare/VA |
$524.98
|
| Rate for Payer: One Health Plan of WY PPO |
$2,159.92
|
| Rate for Payer: PacificSource Commercial |
$1,983.60
|
| Rate for Payer: PHCS PPO |
$2,093.80
|
| Rate for Payer: Three Rivers PPO |
$1,653.00
|
| Rate for Payer: TriWest Veterans Administration |
$617.62
|
| Rate for Payer: United Healthcare Commercial |
$1,917.48
|
| Rate for Payer: United Healthcare Medicare |
$617.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,873.40
|
|
|
HC PRO AMPUTATION FINGER/THUMB
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
9832695101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$586.90 |
| Max. Negotiated Rate |
$2,464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,414.72
|
| Rate for Payer: Aetna of WY Medicare |
$690.47
|
| Rate for Payer: Beech Street Commercial |
$2,340.80
|
| Rate for Payer: Cash Price |
$1,724.80
|
| Rate for Payer: Cash Price |
$1,724.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,390.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,414.72
|
| Rate for Payer: First Choice Health Commercial |
$2,217.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,340.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$690.47
|
| Rate for Payer: HealthUtah PPO |
$2,464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,390.08
|
| Rate for Payer: Multiplan Medicare/VA |
$586.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,414.72
|
| Rate for Payer: PacificSource Commercial |
$2,217.60
|
| Rate for Payer: PHCS PPO |
$2,340.80
|
| Rate for Payer: Three Rivers PPO |
$1,848.00
|
| Rate for Payer: TriWest Veterans Administration |
$690.47
|
| Rate for Payer: United Healthcare Commercial |
$2,143.68
|
| Rate for Payer: United Healthcare Medicare |
$690.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,094.40
|
|
|
HC PRO AMPUTATION FINGER/THUMB,SINGLE
|
Professional
|
Both
|
$2,658.00
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
9832691001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$633.28 |
| Max. Negotiated Rate |
$2,658.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,604.84
|
| Rate for Payer: Aetna of WY Medicare |
$745.04
|
| Rate for Payer: Beech Street Commercial |
$2,525.10
|
| Rate for Payer: Cash Price |
$1,860.60
|
| Rate for Payer: Cash Price |
$1,860.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,578.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,604.84
|
| Rate for Payer: First Choice Health Commercial |
$2,392.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,525.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.04
|
| Rate for Payer: HealthUtah PPO |
$2,658.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,578.26
|
| Rate for Payer: Multiplan Medicare/VA |
$633.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,604.84
|
| Rate for Payer: PacificSource Commercial |
$2,392.20
|
| Rate for Payer: PHCS PPO |
$2,525.10
|
| Rate for Payer: Three Rivers PPO |
$1,993.50
|
| Rate for Payer: TriWest Veterans Administration |
$745.04
|
| Rate for Payer: United Healthcare Commercial |
$2,312.46
|
| Rate for Payer: United Healthcare Medicare |
$745.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,259.30
|
|
|
HC PRO AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 28800
|
| Hospital Charge Code |
9752880001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$434.79 |
| Max. Negotiated Rate |
$2,637.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,584.26
|
| Rate for Payer: Aetna of WY Medicare |
$511.52
|
| Rate for Payer: Beech Street Commercial |
$2,505.15
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,557.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,584.26
|
| Rate for Payer: First Choice Health Commercial |
$2,373.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,505.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$511.52
|
| Rate for Payer: HealthUtah PPO |
$2,637.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,557.89
|
| Rate for Payer: Multiplan Medicare/VA |
$434.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,584.26
|
| Rate for Payer: PacificSource Commercial |
$2,373.30
|
| Rate for Payer: PHCS PPO |
$2,505.15
|
| Rate for Payer: Three Rivers PPO |
$1,977.75
|
| Rate for Payer: TriWest Veterans Administration |
$511.52
|
| Rate for Payer: United Healthcare Commercial |
$2,294.19
|
| Rate for Payer: United Healthcare Medicare |
$511.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,241.45
|
|
|
HC PRO AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
9832880501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$577.67 |
| Max. Negotiated Rate |
$2,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,376.50
|
| Rate for Payer: Aetna of WY Medicare |
$679.61
|
| Rate for Payer: Beech Street Commercial |
$2,303.75
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,697.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,352.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,376.50
|
| Rate for Payer: First Choice Health Commercial |
$2,182.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,303.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.61
|
| Rate for Payer: HealthUtah PPO |
$2,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,352.25
|
| Rate for Payer: Multiplan Medicare/VA |
$577.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,376.50
|
| Rate for Payer: PacificSource Commercial |
$2,182.50
|
| Rate for Payer: PHCS PPO |
$2,303.75
|
| Rate for Payer: Three Rivers PPO |
$1,818.75
|
| Rate for Payer: TriWest Veterans Administration |
$679.61
|
| Rate for Payer: United Healthcare Commercial |
$2,109.75
|
| Rate for Payer: United Healthcare Medicare |
$679.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,061.25
|
|
|
HC PRO AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$3,026.00
|
|
|
Service Code
|
HCPCS 27880
|
| Hospital Charge Code |
9752788001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$720.44 |
| Max. Negotiated Rate |
$3,026.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,965.48
|
| Rate for Payer: Aetna of WY Medicare |
$847.58
|
| Rate for Payer: Beech Street Commercial |
$2,874.70
|
| Rate for Payer: Cash Price |
$2,118.20
|
| Rate for Payer: Cash Price |
$2,118.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,935.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,965.48
|
| Rate for Payer: First Choice Health Commercial |
$2,723.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,874.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.58
|
| Rate for Payer: HealthUtah PPO |
$3,026.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,935.22
|
| Rate for Payer: Multiplan Medicare/VA |
$720.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,965.48
|
| Rate for Payer: PacificSource Commercial |
$2,723.40
|
| Rate for Payer: PHCS PPO |
$2,874.70
|
| Rate for Payer: Three Rivers PPO |
$2,269.50
|
| Rate for Payer: TriWest Veterans Administration |
$847.58
|
| Rate for Payer: United Healthcare Commercial |
$2,632.62
|
| Rate for Payer: United Healthcare Medicare |
$847.58
|
| Rate for Payer: WINHealth Partners Commercial |
$2,572.10
|
|
|
HC PRO AMPUTATION,METATARSAL,W/TOE,S
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
9832881001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$1,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
| Rate for Payer: Aetna of WY Medicare |
$408.70
|
| Rate for Payer: Beech Street Commercial |
$1,384.15
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
| Rate for Payer: First Choice Health Commercial |
$1,311.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.70
|
| Rate for Payer: HealthUtah PPO |
$1,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
| Rate for Payer: Multiplan Medicare/VA |
$347.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
| Rate for Payer: PacificSource Commercial |
$1,311.30
|
| Rate for Payer: PHCS PPO |
$1,384.15
|
| Rate for Payer: Three Rivers PPO |
$1,092.75
|
| Rate for Payer: TriWest Veterans Administration |
$408.70
|
| Rate for Payer: United Healthcare Commercial |
$1,267.59
|
| Rate for Payer: United Healthcare Medicare |
$408.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|
|
HC PRO AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
9832882501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$1,011.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$990.78
|
| Rate for Payer: Aetna of WY Medicare |
$165.87
|
| Rate for Payer: Beech Street Commercial |
$960.45
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$980.67
|
| Rate for Payer: Cigna of WY Commercial |
$990.78
|
| Rate for Payer: First Choice Health Commercial |
$909.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$960.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.87
|
| Rate for Payer: HealthUtah PPO |
$1,011.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$980.67
|
| Rate for Payer: Multiplan Medicare/VA |
$140.99
|
| Rate for Payer: One Health Plan of WY PPO |
$990.78
|
| Rate for Payer: PacificSource Commercial |
$909.90
|
| Rate for Payer: PHCS PPO |
$960.45
|
| Rate for Payer: Three Rivers PPO |
$758.25
|
| Rate for Payer: TriWest Veterans Administration |
$165.87
|
| Rate for Payer: United Healthcare Commercial |
$879.57
|
| Rate for Payer: United Healthcare Medicare |
$165.87
|
| Rate for Payer: WINHealth Partners Commercial |
$859.35
|
|
|
HC PRO AMPUTATION, TOE METARSPHALAN J
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
9832882001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$144.53 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,989.40
|
| Rate for Payer: Aetna of WY Medicare |
$170.04
|
| Rate for Payer: Beech Street Commercial |
$1,928.50
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,969.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,989.40
|
| Rate for Payer: First Choice Health Commercial |
$1,827.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,928.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.04
|
| Rate for Payer: HealthUtah PPO |
$2,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,969.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,989.40
|
| Rate for Payer: PacificSource Commercial |
$1,827.00
|
| Rate for Payer: PHCS PPO |
$1,928.50
|
| Rate for Payer: Three Rivers PPO |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.04
|
| Rate for Payer: United Healthcare Commercial |
$1,766.10
|
| Rate for Payer: United Healthcare Medicare |
$170.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,725.50
|
|
|
HC PRO ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRF EA 9% TBS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01953
|
| Hospital Charge Code |
9640195301
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4-9 % TBSA
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01952
|
| Hospital Charge Code |
9640195201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4 % TBSA
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01951
|
| Hospital Charge Code |
9640195101
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01842
|
| Hospital Charge Code |
9640184201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTERIES OF KNEE & POPLITEAL AREA NOS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01440
|
| Hospital Charge Code |
9640144001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01654
|
| Hospital Charge Code |
9640165401
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01638
|
| Hospital Charge Code |
9640163801
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01830
|
| Hospital Charge Code |
9640183001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01630
|
| Hospital Charge Code |
9640163001
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01636
|
| Hospital Charge Code |
9640163601
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
|
HC PRO ANES ART KNEE POPLITEAL EXC&GRF/ROCCLS/ARYS
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 01444
|
| Hospital Charge Code |
9640144401
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: WINHealth Partners Commercial |
$298.30
|
|
