|
HC PRO APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
9834495501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$2,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,259.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.30
|
| Rate for Payer: Beech Street Commercial |
$2,190.70
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,236.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,259.88
|
| Rate for Payer: First Choice Health Commercial |
$2,075.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$2,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,236.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,259.88
|
| Rate for Payer: PacificSource Commercial |
$2,075.40
|
| Rate for Payer: PHCS PPO |
$2,190.70
|
| Rate for Payer: Three Rivers PPO |
$1,729.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$2,006.22
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.10
|
|
|
HC PRO APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$4,541.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
9834496001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$4,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,450.18
|
| Rate for Payer: Aetna of WY Medicare |
$831.79
|
| Rate for Payer: Beech Street Commercial |
$4,313.95
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,404.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,450.18
|
| Rate for Payer: First Choice Health Commercial |
$4,086.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,313.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.79
|
| Rate for Payer: HealthUtah PPO |
$4,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,404.77
|
| Rate for Payer: Multiplan Medicare/VA |
$707.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,450.18
|
| Rate for Payer: PacificSource Commercial |
$4,086.90
|
| Rate for Payer: PHCS PPO |
$4,313.95
|
| Rate for Payer: Three Rivers PPO |
$3,405.75
|
| Rate for Payer: TriWest Veterans Administration |
$831.79
|
| Rate for Payer: United Healthcare Commercial |
$3,950.67
|
| Rate for Payer: United Healthcare Medicare |
$831.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,859.85
|
|
|
HC PRO APPENDECTOMY
|
Professional
|
Both
|
$3,330.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
9834495001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Aetna of WY Medicare |
$610.31
|
| Rate for Payer: Beech Street Commercial |
$3,163.50
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: First Choice Health Commercial |
$2,997.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.31
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Multiplan Medicare/VA |
$518.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$3,163.50
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$610.31
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Medicare |
$610.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2,830.50
|
|
|
HC PRO APPL GNTLT-HND/LWR FOREARM
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
9832908501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$707.56
|
| Rate for Payer: Aetna of WY Medicare |
$65.43
|
| Rate for Payer: Beech Street Commercial |
$685.90
|
| Rate for Payer: Cash Price |
$505.40
|
| Rate for Payer: Cash Price |
$505.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$700.34
|
| Rate for Payer: Cigna of WY Commercial |
$707.56
|
| Rate for Payer: First Choice Health Commercial |
$649.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$685.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.43
|
| Rate for Payer: HealthUtah PPO |
$722.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$700.34
|
| Rate for Payer: Multiplan Medicare/VA |
$55.62
|
| Rate for Payer: One Health Plan of WY PPO |
$707.56
|
| Rate for Payer: PacificSource Commercial |
$649.80
|
| Rate for Payer: PHCS PPO |
$685.90
|
| Rate for Payer: Three Rivers PPO |
$541.50
|
| Rate for Payer: TriWest Veterans Administration |
$65.43
|
| Rate for Payer: United Healthcare Commercial |
$628.14
|
| Rate for Payer: United Healthcare Medicare |
$65.43
|
| Rate for Payer: WINHealth Partners Commercial |
$613.70
|
|
|
HC PRO APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 29345 NONPBBPAYER
|
| Hospital Charge Code |
9832934501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.06 |
| Max. Negotiated Rate |
$498.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$488.04
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Beech Street Commercial |
$473.10
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$483.06
|
| Rate for Payer: Cigna of WY Commercial |
$488.04
|
| Rate for Payer: First Choice Health Commercial |
$448.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$473.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.36
|
| Rate for Payer: HealthUtah PPO |
$498.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$483.06
|
| Rate for Payer: Multiplan Medicare/VA |
$81.06
|
| Rate for Payer: One Health Plan of WY PPO |
$488.04
|
| Rate for Payer: PacificSource Commercial |
$448.20
|
| Rate for Payer: PHCS PPO |
$473.10
|
| Rate for Payer: Three Rivers PPO |
$373.50
|
| Rate for Payer: TriWest Veterans Administration |
$95.36
|
| Rate for Payer: United Healthcare Commercial |
$433.26
|
| Rate for Payer: United Healthcare Medicare |
$95.36
|
| Rate for Payer: WINHealth Partners Commercial |
$423.30
|
|
|
HC PRO APPLICATION LONG LEG CAST THIGH-TOE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
9832934501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.06 |
| Max. Negotiated Rate |
$398.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$390.04
|
| Rate for Payer: Aetna of WY Medicare |
$95.36
|
| Rate for Payer: Beech Street Commercial |
$378.10
|
| Rate for Payer: Cash Price |
$278.60
|
| Rate for Payer: Cash Price |
$278.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$386.06
|
| Rate for Payer: Cigna of WY Commercial |
$390.04
|
| Rate for Payer: First Choice Health Commercial |
$358.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$378.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.36
|
| Rate for Payer: HealthUtah PPO |
$398.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$386.06
|
| Rate for Payer: Multiplan Medicare/VA |
$81.06
|
| Rate for Payer: One Health Plan of WY PPO |
$390.04
|
| Rate for Payer: PacificSource Commercial |
$358.20
|
| Rate for Payer: PHCS PPO |
$378.10
|
| Rate for Payer: Three Rivers PPO |
$298.50
|
| Rate for Payer: TriWest Veterans Administration |
$95.36
|
| Rate for Payer: United Healthcare Commercial |
$346.26
|
| Rate for Payer: United Healthcare Medicare |
$95.36
|
| Rate for Payer: WINHealth Partners Commercial |
$338.30
|
|
|
HC PRO APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 29355 NONPBBPAYER
|
| Hospital Charge Code |
9832935501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.89 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.30
|
| Rate for Payer: Aetna of WY Medicare |
$102.22
|
| Rate for Payer: Beech Street Commercial |
$508.25
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.95
|
| Rate for Payer: Cigna of WY Commercial |
$524.30
|
| Rate for Payer: First Choice Health Commercial |
$481.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.22
|
| Rate for Payer: HealthUtah PPO |
$535.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.95
|
| Rate for Payer: Multiplan Medicare/VA |
$86.89
|
| Rate for Payer: One Health Plan of WY PPO |
$524.30
|
| Rate for Payer: PacificSource Commercial |
$481.50
|
| Rate for Payer: PHCS PPO |
$508.25
|
| Rate for Payer: Three Rivers PPO |
$401.25
|
| Rate for Payer: TriWest Veterans Administration |
$102.22
|
| Rate for Payer: United Healthcare Commercial |
$465.45
|
| Rate for Payer: United Healthcare Medicare |
$102.22
|
| Rate for Payer: WINHealth Partners Commercial |
$454.75
|
|
|
HC PRO APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 29355
|
| Hospital Charge Code |
9832935501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.89 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$419.44
|
| Rate for Payer: Aetna of WY Medicare |
$102.22
|
| Rate for Payer: Beech Street Commercial |
$406.60
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: Cash Price |
$299.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$415.16
|
| Rate for Payer: Cigna of WY Commercial |
$419.44
|
| Rate for Payer: First Choice Health Commercial |
$385.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$406.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.22
|
| Rate for Payer: HealthUtah PPO |
$428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$415.16
|
| Rate for Payer: Multiplan Medicare/VA |
$86.89
|
| Rate for Payer: One Health Plan of WY PPO |
$419.44
|
| Rate for Payer: PacificSource Commercial |
$385.20
|
| Rate for Payer: PHCS PPO |
$406.60
|
| Rate for Payer: Three Rivers PPO |
$321.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.22
|
| Rate for Payer: United Healthcare Commercial |
$372.36
|
| Rate for Payer: United Healthcare Medicare |
$102.22
|
| Rate for Payer: WINHealth Partners Commercial |
$363.80
|
|
|
HC PRO APPLICATION LONG LEG SPLINT
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29505 NONPBBPAYER
|
| Hospital Charge Code |
9832950501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$50.71
|
| Rate for Payer: Beech Street Commercial |
$239.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: First Choice Health Commercial |
$226.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.71
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$43.10
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$239.40
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$50.71
|
| Rate for Payer: United Healthcare Commercial |
$219.24
|
| Rate for Payer: United Healthcare Medicare |
$50.71
|
| Rate for Payer: WINHealth Partners Commercial |
$214.20
|
|
|
HC PRO APPLICATION LONG LEG SPLINT
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
9832950501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$282.24
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$50.71
|
| Rate for Payer: Aetna of WY Medicare |
$50.71
|
| Rate for Payer: Beech Street Commercial |
$191.90
|
| Rate for Payer: Beech Street Commercial |
$273.60
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$279.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: Cigna of WY Commercial |
$282.24
|
| Rate for Payer: First Choice Health Commercial |
$181.80
|
| Rate for Payer: First Choice Health Commercial |
$259.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$273.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.71
|
| Rate for Payer: HealthUtah PPO |
$288.00
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$279.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$43.10
|
| Rate for Payer: Multiplan Medicare/VA |
$43.10
|
| Rate for Payer: One Health Plan of WY PPO |
$282.24
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PacificSource Commercial |
$259.20
|
| Rate for Payer: PHCS PPO |
$273.60
|
| Rate for Payer: PHCS PPO |
$191.90
|
| Rate for Payer: Three Rivers PPO |
$216.00
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$50.71
|
| Rate for Payer: TriWest Veterans Administration |
$50.71
|
| Rate for Payer: United Healthcare Commercial |
$175.74
|
| Rate for Payer: United Healthcare Commercial |
$250.56
|
| Rate for Payer: United Healthcare Medicare |
$50.71
|
| Rate for Payer: United Healthcare Medicare |
$50.71
|
| Rate for Payer: WINHealth Partners Commercial |
$244.80
|
| Rate for Payer: WINHealth Partners Commercial |
$171.70
|
|
|
HC PRO APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$4,586.00
|
|
|
Service Code
|
HCPCS 20692
|
| Hospital Charge Code |
9832069201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$927.89 |
| Max. Negotiated Rate |
$4,586.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,494.28
|
| Rate for Payer: Aetna of WY Medicare |
$1,091.64
|
| Rate for Payer: Beech Street Commercial |
$4,356.70
|
| Rate for Payer: Cash Price |
$3,210.20
|
| Rate for Payer: Cash Price |
$3,210.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,448.42
|
| Rate for Payer: Cigna of WY Commercial |
$4,494.28
|
| Rate for Payer: First Choice Health Commercial |
$4,127.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,356.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,091.64
|
| Rate for Payer: HealthUtah PPO |
$4,586.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,448.42
|
| Rate for Payer: Multiplan Medicare/VA |
$927.89
|
| Rate for Payer: One Health Plan of WY PPO |
$4,494.28
|
| Rate for Payer: PacificSource Commercial |
$4,127.40
|
| Rate for Payer: PHCS PPO |
$4,356.70
|
| Rate for Payer: Three Rivers PPO |
$3,439.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,091.64
|
| Rate for Payer: United Healthcare Commercial |
$3,989.82
|
| Rate for Payer: United Healthcare Medicare |
$1,091.64
|
| Rate for Payer: WINHealth Partners Commercial |
$3,898.10
|
|
|
HC PRO APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$5,733.00
|
|
|
Service Code
|
HCPCS 20692 NONPBBPAYER
|
| Hospital Charge Code |
9832069201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$927.89 |
| Max. Negotiated Rate |
$5,733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,618.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,091.64
|
| Rate for Payer: Beech Street Commercial |
$5,446.35
|
| Rate for Payer: Cash Price |
$4,013.10
|
| Rate for Payer: Cash Price |
$4,013.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,561.01
|
| Rate for Payer: Cigna of WY Commercial |
$5,618.34
|
| Rate for Payer: First Choice Health Commercial |
$5,159.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,446.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,091.64
|
| Rate for Payer: HealthUtah PPO |
$5,733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,561.01
|
| Rate for Payer: Multiplan Medicare/VA |
$927.89
|
| Rate for Payer: One Health Plan of WY PPO |
$5,618.34
|
| Rate for Payer: PacificSource Commercial |
$5,159.70
|
| Rate for Payer: PHCS PPO |
$5,446.35
|
| Rate for Payer: Three Rivers PPO |
$4,299.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,091.64
|
| Rate for Payer: United Healthcare Commercial |
$4,987.71
|
| Rate for Payer: United Healthcare Medicare |
$1,091.64
|
| Rate for Payer: WINHealth Partners Commercial |
$4,873.05
|
|
|
HC PRO APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
9832940501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$383.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$232.26
|
| Rate for Payer: Aetna of WY Medicare |
$56.85
|
| Rate for Payer: Aetna of WY Medicare |
$56.85
|
| Rate for Payer: Beech Street Commercial |
$225.15
|
| Rate for Payer: Beech Street Commercial |
$371.45
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: Cash Price |
$273.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$379.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$229.89
|
| Rate for Payer: Cigna of WY Commercial |
$232.26
|
| Rate for Payer: Cigna of WY Commercial |
$383.18
|
| Rate for Payer: First Choice Health Commercial |
$213.30
|
| Rate for Payer: First Choice Health Commercial |
$351.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$371.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$225.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.85
|
| Rate for Payer: HealthUtah PPO |
$391.00
|
| Rate for Payer: HealthUtah PPO |
$237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$379.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$229.89
|
| Rate for Payer: Multiplan Medicare/VA |
$48.32
|
| Rate for Payer: Multiplan Medicare/VA |
$48.32
|
| Rate for Payer: One Health Plan of WY PPO |
$383.18
|
| Rate for Payer: One Health Plan of WY PPO |
$232.26
|
| Rate for Payer: PacificSource Commercial |
$213.30
|
| Rate for Payer: PacificSource Commercial |
$351.90
|
| Rate for Payer: PHCS PPO |
$371.45
|
| Rate for Payer: PHCS PPO |
$225.15
|
| Rate for Payer: Three Rivers PPO |
$293.25
|
| Rate for Payer: Three Rivers PPO |
$177.75
|
| Rate for Payer: TriWest Veterans Administration |
$56.85
|
| Rate for Payer: TriWest Veterans Administration |
$56.85
|
| Rate for Payer: United Healthcare Commercial |
$206.19
|
| Rate for Payer: United Healthcare Commercial |
$340.17
|
| Rate for Payer: United Healthcare Medicare |
$56.85
|
| Rate for Payer: United Healthcare Medicare |
$56.85
|
| Rate for Payer: WINHealth Partners Commercial |
$332.35
|
| Rate for Payer: WINHealth Partners Commercial |
$201.45
|
|
|
HC PRO APPLICATION SHORT LEG CAST BELOW KNEE-TOE
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 29405 NONPBBPAYER
|
| Hospital Charge Code |
9832940501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$56.85
|
| Rate for Payer: Beech Street Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: First Choice Health Commercial |
$266.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.85
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$48.32
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$281.20
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$56.85
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$56.85
|
| Rate for Payer: WINHealth Partners Commercial |
$251.60
|
|
|
HC PRO APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
9832942501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$217.56
|
| Rate for Payer: Aetna of WY Medicare |
$52.52
|
| Rate for Payer: Beech Street Commercial |
$210.90
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$215.34
|
| Rate for Payer: Cigna of WY Commercial |
$217.56
|
| Rate for Payer: First Choice Health Commercial |
$199.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$210.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.52
|
| Rate for Payer: HealthUtah PPO |
$222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$215.34
|
| Rate for Payer: Multiplan Medicare/VA |
$44.64
|
| Rate for Payer: One Health Plan of WY PPO |
$217.56
|
| Rate for Payer: PacificSource Commercial |
$199.80
|
| Rate for Payer: PHCS PPO |
$210.90
|
| Rate for Payer: Three Rivers PPO |
$166.50
|
| Rate for Payer: TriWest Veterans Administration |
$52.52
|
| Rate for Payer: United Healthcare Commercial |
$193.14
|
| Rate for Payer: United Healthcare Medicare |
$52.52
|
| Rate for Payer: WINHealth Partners Commercial |
$188.70
|
|
|
HC PRO APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 29425 NONPBBPAYER
|
| Hospital Charge Code |
9832942501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$52.52
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.52
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$44.64
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$52.52
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$52.52
|
| Rate for Payer: WINHealth Partners Commercial |
$235.45
|
|
|
HC PRO APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$3,055.00
|
|
|
Service Code
|
HCPCS 20690 NONPBBPAYER
|
| Hospital Charge Code |
9832069001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$489.61 |
| Max. Negotiated Rate |
$3,055.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,993.90
|
| Rate for Payer: Aetna of WY Medicare |
$576.01
|
| Rate for Payer: Beech Street Commercial |
$2,902.25
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,963.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,993.90
|
| Rate for Payer: First Choice Health Commercial |
$2,749.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,902.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.01
|
| Rate for Payer: HealthUtah PPO |
$3,055.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,963.35
|
| Rate for Payer: Multiplan Medicare/VA |
$489.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2,993.90
|
| Rate for Payer: PacificSource Commercial |
$2,749.50
|
| Rate for Payer: PHCS PPO |
$2,902.25
|
| Rate for Payer: Three Rivers PPO |
$2,291.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.01
|
| Rate for Payer: United Healthcare Commercial |
$2,657.85
|
| Rate for Payer: United Healthcare Medicare |
$576.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,596.75
|
|
|
HC PRO APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
9832069001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$489.61 |
| Max. Negotiated Rate |
$2,444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,395.12
|
| Rate for Payer: Aetna of WY Medicare |
$576.01
|
| Rate for Payer: Beech Street Commercial |
$2,321.80
|
| Rate for Payer: Cash Price |
$1,710.80
|
| Rate for Payer: Cash Price |
$1,710.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,370.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,395.12
|
| Rate for Payer: First Choice Health Commercial |
$2,199.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,321.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.01
|
| Rate for Payer: HealthUtah PPO |
$2,444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,370.68
|
| Rate for Payer: Multiplan Medicare/VA |
$489.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2,395.12
|
| Rate for Payer: PacificSource Commercial |
$2,199.60
|
| Rate for Payer: PHCS PPO |
$2,321.80
|
| Rate for Payer: Three Rivers PPO |
$1,833.00
|
| Rate for Payer: TriWest Veterans Administration |
$576.01
|
| Rate for Payer: United Healthcare Commercial |
$2,126.28
|
| Rate for Payer: United Healthcare Medicare |
$576.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,077.40
|
|
|
HC PRO APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
9832958101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.16
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$419.90
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.74
|
| Rate for Payer: Cigna of WY Commercial |
$433.16
|
| Rate for Payer: First Choice Health Commercial |
$397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$419.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$442.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.74
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$433.16
|
| Rate for Payer: PacificSource Commercial |
$397.80
|
| Rate for Payer: PHCS PPO |
$419.90
|
| Rate for Payer: Three Rivers PPO |
$331.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$384.54
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$375.70
|
|
|
HC PRO APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 29581 NONPBBPAYER
|
| Hospital Charge Code |
9832958101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$541.94
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$525.35
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$536.41
|
| Rate for Payer: Cigna of WY Commercial |
$541.94
|
| Rate for Payer: First Choice Health Commercial |
$497.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$536.41
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$541.94
|
| Rate for Payer: PacificSource Commercial |
$497.70
|
| Rate for Payer: PHCS PPO |
$525.35
|
| Rate for Payer: Three Rivers PPO |
$414.75
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$481.11
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$470.05
|
|
|
HC PRO APPL SPLINT SHT ARM DYNAM
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
9832912601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.74 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$424.34
|
| Rate for Payer: Aetna of WY Medicare |
$47.93
|
| Rate for Payer: Beech Street Commercial |
$411.35
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.01
|
| Rate for Payer: Cigna of WY Commercial |
$424.34
|
| Rate for Payer: First Choice Health Commercial |
$389.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$411.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.93
|
| Rate for Payer: HealthUtah PPO |
$433.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.01
|
| Rate for Payer: Multiplan Medicare/VA |
$40.74
|
| Rate for Payer: One Health Plan of WY PPO |
$424.34
|
| Rate for Payer: PacificSource Commercial |
$389.70
|
| Rate for Payer: PHCS PPO |
$411.35
|
| Rate for Payer: Three Rivers PPO |
$324.75
|
| Rate for Payer: TriWest Veterans Administration |
$47.93
|
| Rate for Payer: United Healthcare Commercial |
$376.71
|
| Rate for Payer: United Healthcare Medicare |
$47.93
|
| Rate for Payer: WINHealth Partners Commercial |
$368.05
|
|
|
HC PRO APPLY FINGER SPLINT,STATIC
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
9832913001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$114.66
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$168.15
|
| Rate for Payer: Beech Street Commercial |
$111.15
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$113.49
|
| Rate for Payer: Cigna of WY Commercial |
$114.66
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: First Choice Health Commercial |
$159.30
|
| Rate for Payer: First Choice Health Commercial |
$105.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$117.00
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$113.49
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: One Health Plan of WY PPO |
$114.66
|
| Rate for Payer: PacificSource Commercial |
$105.30
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$111.15
|
| Rate for Payer: PHCS PPO |
$168.15
|
| Rate for Payer: Three Rivers PPO |
$87.75
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: United Healthcare Commercial |
$101.79
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$99.45
|
| Rate for Payer: WINHealth Partners Commercial |
$150.45
|
|
|
HC PRO APPLY FINGER SPLINT,STATIC
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 29130 NONPBBPAYER
|
| Hospital Charge Code |
9832913001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: First Choice Health Commercial |
$131.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$138.70
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$124.10
|
|
|
HC PRO APPLY FOREARM CAST
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 29075 NONPBBPAYER
|
| Hospital Charge Code |
9832907501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.82
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$293.55
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.73
|
| Rate for Payer: Cigna of WY Commercial |
$302.82
|
| Rate for Payer: First Choice Health Commercial |
$278.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.73
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$302.82
|
| Rate for Payer: PacificSource Commercial |
$278.10
|
| Rate for Payer: PHCS PPO |
$293.55
|
| Rate for Payer: Three Rivers PPO |
$231.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$268.83
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: WINHealth Partners Commercial |
$262.65
|
|
|
HC PRO APPLY FOREARM CAST
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 29075 50,NONPBBPAYER
|
| Hospital Charge Code |
9832907501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$587.10
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: First Choice Health Commercial |
$556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$587.10
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
